Infants with congenital heart disease (CHD) often experience developmental delays, especially those requiring neonatal surgery. Cerebral autoregulation, which maintains stable brain blood flow despite changes in blood pressure, is crucial in preventing injury. This retrospective cohort study analyzed full-term neonates who underwent open-heart surgery on cardiopulmonary bypass at Columbia University Irving Medical Center between 2020-2022. Exclusion criteria included incomplete records, premature birth, ECMO use, or insufficient physiological data. The primary outcome was the optimal mean arterial pressure (MAP_OPT) determined by autoregulation, calculated using the cerebral oximetry index (COx), which measures the correlation between mean arterial pressure (MAP) and cerebral near-infrared spectroscopy (NIRS) values.

The study included 75 patients, 35% with single ventricles, and 61% male. The most common procedures were arterial switch (ASO), aortic arch repair, right modified Blaylock-Taussig-Thomas shunt (RmBTTS), and Norwood. On average, patients spent 43% of the time below MAP_OPT and 26.7% within the target range in the first 48 hours postoperatively. Time spent within MAP_OPT differed by surgical procedure (p < 0.001), and time below MAP_OPT was associated with the procedure but not the CHD diagnosis. Specifically, RmBTTS and ASO showed initial improvements, while Norwood and arch repairs showed worsening. These findings highlight the challenge of maintaining optimal MAP after surgery and suggest that deviations from MAP_OPT may contribute to brain injury.