Cardiology in the Young

Original Articles

Infection and white matter injury in infants with congenital cardiac disease

Hannah C. Glassa1a2 c1, Chelsea Bowmana1, Vann Chaua5, Alisha Moosaa5, Adam L. Hersha2, Andrew Campbella6, Kenneth Poskitta7, Anthony Azakiea3, A. James Barkovicha4, Steven P. Millera5 and Patrick S. McQuillena2

a1 Department of Neurology, University of California, San Francisco, United States of America

a2 Department of Pediatrics, University of California, San Francisco, United States of America

a3 Department of Cardiothoracic Surgery, University of California, San Francisco, United States of America

a4 Department of Radiology, University of California, San Francisco, United States of America

a5 Department of Pediatrics, University of British Columbia, Vancouver, Canada

a6 Department of Cardiothoracic Surgery, University of British Columbia, Vancouver, Canada

a7 Department of Radiology, University of British Columbia, Vancouver, Canada

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.

(Received September 10 2010)

(Accepted March 03 2011)

(Online publication April 19 2011)

Correspondence:

c1 Correspondence to: H. C. Glass, MDCM, MAS, FRCPC, Department of Neurology, University of California San Francisco, Box 0663, 521 Parnassus Avenue, C-215, San Francisco, California 94143-0663, United States of America. Tel: 415 514 3277; Fax: 415 502 5821; E-mail: Hannah.Glass@ucsf.edu

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