Noninvasive optical monitoring of cerebral hemodynamics immediately after birth in neonates with congenital heart disease

Objective: Critical congenital heart disease is associated with altered cerebral hemodynamics in the neonatal period, but the effect on cerebral physiology earlier in life during the fetal to neonatal transition period is yet to be elucidated. This period of neonatal resuscitation could represent an opportunity for intervention, so we aimed to characterize cerebral hemodynamics immediately after birth in four neonates with critical congenital heart disease using noninvasive optical monitoring. Methods: This case series analysis included term neonates with hypoplastic left heart syndrome or with transposition of the great arteries who were born at Children’s Hospital of Philadelphia. Continuous measurements of cerebral blood flow, cerebral tissue oxygen saturation, and cerebral metabolic rate of oxygen were acquired non-invasively during the first hour after birth with near-infrared spectroscopy, frequency-domain diffuse optical spectroscopy, and diffuse correlation spectroscopy techniques. Results: In all four newborns, cerebral tissue oxygen saturation was lower than reference values in the literature. Additionally, we observed decreases in cerebral blood flow and oxygen metabolism during postnatal transition that were not reflected by standard of care metrics such as peripheral oxygen saturation. The decreases were spontaneous in infants with hypoplastic left heart syndrome and temporally associated with invasive respiratory support in infants with transposition of the great arteries. Conclusion: This case series demonstrates periods of possible neurological vulnerability during postnatal transition in critical congenital heart disease and motivates further study of cerebral physiology during the transition period using advanced optical techniques.