Onset of brain injury in infants with prenatally diagnosed congenital heart disease

Background The exact onset of brain injury in infants with congenital heart disease (CHD) is unknown. Our aim was, therefore, to assess the association between prenatal Doppler flow patterns, postnatal cerebral oxygenation and short-term neurological outcome. Methods Prenatally, we measured pulsatility indices of the middle cerebral (MCA-PI) and umbilical artery (UA-PI) and calculated cerebroplacental ratio (CPR). After birth, cerebral oxygen saturation (r(c)SO(2)) and fractional tissue oxygen extraction (FTOE) were assessed during the first 3 days after birth, and during and for 24 hours after every surgical procedure within the first 3 months after birth. Neurological outcome was determined preoperatively and at 3 months of age by assessing general movements and calculating the Motor Optimality Score (MOS). Results Thirty-six infants were included. MOS at 3 months was associated with MCA-PI (rho 0.41, P = 0.04), UA-PI (rho -0.39, P = 0.047, and CPR (rho 0.50, P = 0.01). Infants with abnormal MOS had lower MCA-PI (P = 0.02) and CPR (P = 0.01) and higher UA-PI at the last measurement (P = 0.03) before birth. In infants with abnormal MOS, r(c)SO(2) tended to be lower during the first 3 days after birth, and FTOE was significantly higher on the second day after birth (P = 0.04). Intraoperative and postoperative r(c)SO(2) and FTOE were not associated with short-term neurological outcome. Conclusion In infants with prenatally diagnosed CHD, the prenatal period may play an important role in developmental outcome. Additional research is needed to clarify the relationship between preoperative, intra-operative and postoperative cerebral oxygenation and developmental outcome in infants with prenatally diagnosed CHD

ACT measurement: The biased gold standard of measuring heparin anticoagulation in cardiac surgery

Introduction: In cardiac surgery anticoagulation is usually achieved by administration of heparin. For nearly 50 years the activated clotting time (ACT) has been known as a practicable method to measure this effect [1]. Despite its widespread use, a degree of uncertainty remains concerning its validity and repeatability. Furthermore, ACT measurements can vary based on the measurement method [2]. A smaller trial suggests that there is no statistically significant difference in ACT measurement using the same system [3]. Taking two samples from the same patient at the same time and measuring withthe same Hemochron Response® machine, we compared repeatability of ACT measurements.  Methods: In this retrospective observational study, we compared duplicate ACT values in patients undergoing cardiac surgery in our institution between January 2010 and May 2012. We used Bland-Altman analysis to look for differences between the two measurements.  Results: 11569 pairs of duplicate ACT measurements were analysed. Mean bias was –19.5 s (P < 0.05), 95% confidence interval was –20.6 s to 18.3 s. 2,540 pairs (22.0%) varied by more than 10%, 1,831 (15.8%) by more than 20%.  Discussion: In our institution, a substantial proportion of ACT measurements taken at the same moment from the same patient vary significantly. This disagreement should be considered when defining target areas for anticoagulation to ensure patient safety.  References: [1] Hattersley PG. Activated coagulation time of whole blood. JAMA 1966; 196:436-440.   [2] Thenappan T, Swamy R, Shah A, et al. Interchangeability of activated clotting time values across different point-of-care systems. Am J Cardiol 2012; 109:1379-1382.  [3] Bosch YP, Ganushchak YM, de Yong DS. Comparison of ACT point-of-care measurements: repeatability and agreement. Perfusion 2006; 21: 27-31

Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study

Purpose: Non-invasive cerebral oxygen saturation (ScO2) monitoring is an established tool in the intraoperative phase of pediatric congenital cardiac surgery (CCS). This study investigated the association between ScO2 and postoperative outcome by investigating both baseline ScO2 values and intraoperative desaturations from baseline. Methods: All CCS procedures performed in the period 2010-2017 in our institution in which ScO2 was monitored were included in this historical cohort study. Baseline ScO2 was determined after tracheal intubation, before surgical incision. Subgroups were based on cardiac pathology and degree of intracardiac shunting. Poor outcome was defined based on length of stay (LOS) in the intensive care unit (ICU)/hospital, duration of mechanical ventilation (MV), and 30-day mortality. Intraoperatively, ScO2 total time below baseline (TBBL) and ScO2 time-weighted average (TWA) were calculated. Results: Data from 565 patients were analyzed. Baseline ScO2 was significantly associated with LOS in ICU (odds ratio [OR] per percentage decrease in baseline ScO2, 0.95; 95% confidence interval [CI], 0.93 to 0.97; P < 0.001), with LOS in hospital (OR, 0.93; 95% CI, 0.91 to 0.96; P < 0.001), with MV duration (OR, 0.92; 95% CI, 0.90 to 0.95; P < 0.001) and with 30-day mortality (OR, 0.94; 95% CI, 0.91 to 0.98; P = 0.007). Cerebral oxygen saturation TWA had no associations, while ScO2 TBBL had only a small association with LOS in ICU (OR, 1.02; 95% CI, 1.01 to 1.03; P < 0.001), MV duration (OR,1.02; 95% CI, 1.01 to 1.03; P = 0.002), and LOS in hospital (OR, 1.02; 95% CI, 1.01 to 1.04; P < 0.001). Conclusion: In pediatric patients undergoing cardiac surgery, low baseline ScO2 values measured after tracheal intubation were associated with several adverse postoperative outcomes. In contrast, the severity of actual intraoperative cerebral desaturation was not associated with postoperative outcomes. Baseline ScO2 measured after tracheal intubation may help identify patients at increased perioperative risk

Analysis of female physical activity characteristics according to age and ponderal status in a free-living context: a study from a central Italy sample

none10nononeDi Blasio, Andrea; Napolitano, Giorgio; Di Donato, Francesco; Izzicupo, Pascal; Di Baldassarre, Angela; Modestini, Elisabetta; Bergamin, Marco; Bullo, Valentina; Bucci, Ines; Di Pietro, MarioDi Blasio, Andrea; Napolitano, Giorgio; Di Donato, Francesco; Izzicupo, Pascal; Di Baldassarre, Angela; Modestini, Elisabetta; Bergamin, Marco; Bullo, Valentina; Bucci, Ines; DI PIETRO, Mari