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Infection and white matter injury in infants with congenital cardiac disease

Published online by Cambridge University Press:  19 April 2011


Hannah C. Glass
Affiliation:
Department of Neurology, University of California, San Francisco, United States of America Department of Pediatrics, University of California, San Francisco, United States of America
Chelsea Bowman
Affiliation:
Department of Neurology, University of California, San Francisco, United States of America
Vann Chau
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, Canada
Alisha Moosa
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, Canada
Adam L. Hersh
Affiliation:
Department of Pediatrics, University of California, San Francisco, United States of America
Andrew Campbell
Affiliation:
Department of Cardiothoracic Surgery, University of British Columbia, Vancouver, Canada
Kenneth Poskitt
Affiliation:
Department of Radiology, University of British Columbia, Vancouver, Canada
Anthony Azakie
Affiliation:
Department of Cardiothoracic Surgery, University of California, San Francisco, United States of America
A. James Barkovich
Affiliation:
Department of Radiology, University of California, San Francisco, United States of America
Steven P. Miller
Affiliation:
Department of Pediatrics, University of British Columbia, Vancouver, Canada
Patrick S. McQuillen
Affiliation:
Department of Pediatrics, University of California, San Francisco, United States of America
Corresponding
E-mail address:

Abstract

More than 60% of newborns with severe congenital cardiac disease develop perioperative brain injuries. Known risk factors include: pre-operative hypoxemia, cardiopulmonary bypass characteristics, and post-operative hypotension. Infection is an established risk factor for white matter injury in premature newborns. In this study, we examined term infants with congenital cardiac disease requiring surgical repair to determine whether infection is associated with white matter injury. Acquired infection was specified by site – bloodstream, pneumonia, or surgical site infection – according to strict definitions. Infection was present in 23 of 127 infants. Pre- and post-operative imaging was evaluated for acquired injury by a paediatric neuroradiologist. Overall, there was no difference in newly acquired post-operative white matter injury in infants with infection (30%), compared to those without (31%). When stratified by anatomy, infants with transposition of the great arteries, and bloodstream infection had an estimated doubling of risk of white matter injury that was not significant, whereas those with single ventricle anatomy had no apparent added risk. When considering only infants without stroke, the estimated association was higher, and became significant after adjusting for duration of inotrope therapy. In this study, nosocomial infection was not associated with white matter injury. Nonetheless, when controlling for risk factors, there was an association between bloodstream infection and white matter injury in selected sub-populations. Infection prevention may have the potential to mitigate long-term neurologic impairment as a consequence of white matter injury, which underscores the importance of attention to infection control for these patients.


Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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