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Pediatrics. 2015 May;135(5):816-25. doi: 10.1542/peds.2014-3825.

Neurodevelopmental outcomes after cardiac surgery in infancy.

Author information

1
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; gaynor@email.chop.edu.
2
Boston Children's Hospital, Boston, Massachusetts;
3
Texas Children's Hospital, Houston, Texas;
4
Stollery Children's Hospital and the Western Canadian Complex Pediatric Therapies Follow-up Program, Edmonton, Alberta, Canada;
5
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina;
6
Starship Children's Hospital, Auckland, New Zealand;
7
Children's National Medical Center, Washington, District of Columbia;
8
Children's Hospital and Medical Center, Omaha, Nebraska;
9
Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;
10
Mott's Children's Hospital, Ann Arbor, Michigan;
11
University Hospital Aachen, Aachen, Germany;
12
Toyama University Hospital, Toyama, Japan;
13
Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida;
14
University of Queensland, Brisbane, Australia;
15
University Children's Hospital Zurich, Zurich, Switzerland;
16
Duke University Medical Center, Durham, North Carolina;
17
Children's Healthcare of Atlanta, Atlanta, Georgia;
18
University of California, San Francisco, San Francisco, California;
19
Primary Children's Medical Center, Salt Lake City, Utah;
20
National Heart, Lung, and Blood Institute, Bethesda, Maryland;
21
Children's Hospital Los Angeles, Los Angeles, California;
22
Alfred I. duPont Hospital for Children, Wilmington, Delaware;
23
The Royal Children's Hospital, Melbourne, Australia;
24
University of British Columbia, Vancouver, British Columbia, Canada; and.
25
New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, New York.

Abstract

BACKGROUND:

Neurodevelopmental disability is the most common complication for survivors of surgery for congenital heart disease (CHD).

METHODS:

We analyzed individual participant data from studies of children evaluated with the Bayley Scales of Infant Development, second edition, after cardiac surgery between 1996 and 2009. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI).

RESULTS:

Among 1770 subjects from 22 institutions, assessed at age 14.5 ± 3.7 months, PDIs and MDIs (77.6 ± 18.8 and 88.2 ± 16.7, respectively) were lower than normative means (each P < .001). Later calendar year of birth was associated with an increased proportion of high-risk infants (complexity of CHD and prevalence of genetic/extracardiac anomalies). After adjustment for center and type of CHD, later year of birth was not significantly associated with better PDI or MDI. Risk factors for lower PDI were lower birth weight, white race, and presence of a genetic/extracardiac anomaly (all P ≤ .01). After adjustment for these factors, PDIs improved over time (0.39 points/year, 95% confidence interval 0.01 to 0.78; P = .045). Risk factors for lower MDI were lower birth weight, male gender, less maternal education, and presence of a genetic/extracardiac anomaly (all P < .001). After adjustment for these factors, MDIs improved over time (0.38 points/year, 95% confidence interval 0.05 to 0.71; P = .02).

CONCLUSIONS:

Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved modestly over time, but only after adjustment for innate patient risk factors. As more high-risk CHD infants undergo cardiac surgery and survive, a growing population will require significant societal resources.

KEYWORDS:

cardiac surgery; cardiopulmonary bypass; congenital heart defects; neurodevelopmental outcomes

PMID:
25917996
PMCID:
PMC4533222
DOI:
10.1542/peds.2014-3825
[Indexed for MEDLINE]
Free PMC Article

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