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Präoperative Azidose und Entwicklung von Säuglingen nach Operation angeborener Herzfehler

Preoperative acidosis and infant development following surgery for congenital heart disease

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Zusammenfassung

Hintergrund

Frühere Studien haben gezeigt, dass durch pränatale Diagnostik eine präoperative Azidose vermindert und dadurch eine gestörte postnatale Entwicklung vermieden werden kann. Ziel der vorliegenden Studie ist es, die verschiedenen Parameter für eine Azidose und deren prognostischen Wert für die postnatale Entwicklung bei Neugeborenen mit angeborener Herzkrankheit zu untersuchen.

Methode

Es wurden 117 Patienten, bei denen innerhalb des ersten Lebensmonats ein angeborener Herzfehler operativ behandelt werden musste, in die Studie aufgenommen. Die Diagnose wurde entweder prä- oder postnatal gestellt. Die präoperativen Werte für Laktat, pH und Basenüberschuss wurden mit dem Auftreten einer verzögerten Entwicklung verglichen, d. h. eine Verzögerung von mehr als 10% auf der P90 der standardisierten Dutch Developmental Scale. Die Patienten wurden entsprechend der Serumwerte für Azidose in Gruppen eingeteilt.

Resultate

Es wurden keine signifikanten Unterschiede in der Entwicklung festgestellt in Abhängigkeit von pH oder Basenüberschuss. Präoperative Laktatwerte >6,1 mmol/l resultierten in einer deutlichen verzögerten Entwicklung verglichen mit Kindern mit präoperativen Laktatwerten <6,1 mmol/l: 40,9% gegenüber 15,1% (p=0,03).

Schlussfolgerung

Präoperative Laktatwerte besitzen einen prognostischen Wert für die Entwicklung beim Neugeborenen mit angeborenem Herzfehler. Der beschränkte prognostische Aussagekraft des pH kann durch den Umstand erklärt werden, dass der pH relativ einfach korrigiert werden kann, während das Laktat die gesamte Sauerstoffschuld bei dieser Patientengruppe besser widerspiegelt.

Abstract

Objective

Prenatal diagnosis has been shown to decrease pre-operative acidosis and might prevent the occurrence of disturbed developmental outcome. The aim of this study is to evaluate parameters for acidosis and their predictive value on developmental outcome in newborns with congenital heart disease.

Methods

A total of 117 patients requiring surgery for structural heart disease in the first 31 days of life were included. Diagnosis was established either pre- or postnatally. Preoperative values of lactate, pH and base excess levels were compared to the occurrence of disturbed developmental outcome, i.e. an underperformance of more than 10% on the P90 of a standardized Dutch developmental scale. Patients were divided into groups according to blood levels of acidosis parameters, using receiver operating characteristics curves to determine cut-off values for pH, base excess and lactate.

Results

No significant difference in developmental outcome was found using values for pH or base excess as a cut-off level. Preoperative lactate values exceeding 6.1 mmol/l resulted in a significant increase in impaired development compared to infants with a pre-operative lactate lower than 6.1 mmol/l: 40.9% vs 15.1% in (p=0.03).

Conclusions

Pre-operative lactate values might have a prognostic value on developmental outcome in newborns with congenital heart disease. The limited prognostic value of pH can be explained by the fact that pH can be easily corrected, while lactate better reflects the total oxygen debt experienced by these patients.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Brisbane and Women’s Hospital, Herston, 4006, Herston, Australia

    P.M. Verheijen

  2. Nuffield Orthopaedic Centre, Oxford, United Kingdom

    L.A. Lisowski MD, PhD

  3. Department of Orthopedic Surgery, Spaarne Hospital, Hoofddorp, Hoofddorp, The Netherlands

    S. Wassink

  4. Department of Obstetrics, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands

    G.H.A. Visser

  5. Division of Pediatric Cardiology, CHUV, University of Lausanne, Lausanne, Switzerland

    E.J. Meijboom

  6. Flat 8, Room 27 Randolph Court, Churchill Drive, OX3 7NR, Oxford, United Kingdom

    L.A. Lisowski MD, PhD

Authors
  1. P.M. Verheijen
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  2. L.A. Lisowski MD, PhD
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  3. S. Wassink
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  4. G.H.A. Visser
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  5. E.J. Meijboom
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Corresponding author

Correspondence to L.A. Lisowski MD, PhD.

Additional information

Research established at: Division of Pediatric Cardiology, Wilhelmina Children’s Hospital, UMC Utrecht, the Netherlands.

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Verheijen, P., Lisowski, L., Wassink, S. et al. Präoperative Azidose und Entwicklung von Säuglingen nach Operation angeborener Herzfehler. Herz 35, 358–363 (2010). https://doi.org/10.1007/s00059-010-3356-9

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  • DOI: https://doi.org/10.1007/s00059-010-3356-9

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