Longitudinal patterns of postoperative brain oxygen saturation in children with congenital heart disease and postoperative delirium risk: a repeated measures analysis.

OBJECTIVE

To investigate longitudinal patterns of regional cerebral oxygen saturation (CrSO2) after cardiopulmonary bypass (CPB) surgery in children with congenital heart disease (CHD) and their association with postoperative delirium (POD).

METHODS

A prospective longitudinal study was conducted involving 65 pediatric patients undergoing corrective cardiac surgery with CPB. CrSO2 level were monitored at 6 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) postoperatively. POD was assessed using the Cornell Assessment of Pediatric Delirium (CAPD). Multivariate logistic regression and linear mixed-effects models (LMMs) were applied to analyze CrSO2 trajectories and their association with POD.

RESULTS

The incidence of POD was 47.7% (31/65). Univariate analysis showed significantly lower CrSO2 levels at T1-T4 and minimum CrSO2 values in the POD group compared to the NPOD group (all P < 0.05). Multivariate logistic regression indicated that lower CrSO2 levels in the early postoperative period independently predicted POD (OR = 0.941, 95% CI: 0.894-0.991, P = 0.021). The model exhibited good fit (P = 0.037) and passed the Hosmer-Lemeshow test (P = 0.132). LMM analysis revealed significantly lower CrSO2 levels in the POD group at 6 h, 12 h, and 48 h postoperatively (Bonferroni-corrected P-values: 0.009, 0.030, and 0.018, respectively), although the overall CrSO2 trend over time was similar between groups.

CONCLUSION

Early postoperative CrSO2 dynamics in pediatric CHD patients undergoing CPB are independently associated with POD. Children in the POD group exhibited consistently lower CrSO2 levels, especially at 6, 12, and 48 h postoperatively. Continuous monitoring of CrSO2 could facilitate early detection and timely intervention for POD.