Pilot Study: The Association Between Infant Brain Injury and Repeated Anesthesia Exposure, Poster 40

Infants born with congenital long-gap esophageal atresia (LGEA) undergo complex neonatal surgical repair (Foker Process) requiring prolonged and repeated anesthesia exposure in the context of critical illness. Our... [ view full abstract ]

Infants born with congenital long-gap esophageal atresia (LGEA) undergo complex neonatal surgical repair (Foker Process) requiring prolonged and repeated anesthesia exposure in the context of critical illness. Our understanding of such treatment on the developing brain is limited. We hypothesized that cumulative anesthesia exposure is associated with increased incidence of neuroradiological MRI findings in premature but not full-term critically-ill infants. Full-term (n=9) and preterm (n=13) patients with history of LGEA (without any genetic abnormalities or neurological disease), < 1 year of age underwent non-sedated structural MRI using a 3T Siemens scanner, as per IRB approval at Boston Children’s Hospital. We quantified: (1) number of anesthesia events, (2) cumulative hours of anesthesia exposure prior to brain MRI, and total number of incidental (3) brain and (4) cranium MRI findings. Linear correlations between measures were assessed using Pearson’s correlation. Qualitative neuroradiological reports showed findings in cerebrospinal fluid, gray and white matter in both full-term and preterm patients. Total number of anesthesia events for either patient group was not associated to number of MRI findings. We report positive linear correlations between hours of cumulative anesthesia exposure and both the number of incidental (1) cranium (r=0.908, p<0.001), and (2) brain (r=0.633, p=0.067) MRI findings in full-term, but not preterm infants. Future studies should investigate the impact of other confounding factors (e.g. disease, surgical complications, antibiotic and muscle relaxation use, prolonged sedation, and parenteral nutrition).

Supported by NIH K08 DA035972-01 and Trailblazer Award (D. Bajic).