A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease

Suzanne H. Snookes, Julia K. Gunn, Bev J. Eldridge, Susan M. Donath, Rod W. Hunt, Mary P. Galea, Lara Shekerdemian

Research output: Contribution to journalReview ArticleResearchpeer-review

157 Citations (Scopus)


CONTEXT: Brain injury is the most common long-term complication of congenital heart disease requiring surgery during infancy. It is clear that the youngest patients undergoing cardiac surgery, primarily neo-nates and young infants, are at the greatest risk for brain injury. Develop-mental anomalies sustained early in life have lifelong repercussions. OBJECTIVE: We conducted a systematic reviewto examine longitudinal studies of cognitive and/or motor outcome after cardiac surgery dur-ing early infancy. METHODS: Electronic searches were performed in Medline, the Cumu-lative Index to Nursing and Allied Health Literature (Cinahl), and Em-base (1998-2008). The search strategy yielded 327 articles, of which 65 were reviewed. Eight cohorts provided prospective data regarding the cognitive and/or motor outcome of infants who had undergone surgery for congenital heart disease before 6 months of age. Two authors, Ms Snookes and Dr Gunn, independently extracted data and presented results according to 3 subgroups for age of follow-up: early develop-ment (1 to <3 years); preschool age (3-5 years); and school age (>5 to 17 years). Weighted analysis was undertaken to pool the results of studies when appropriate. RESULTS: All of the identified studies reported results of the Bayley Scales of Infant Development for children younger than the age of 3. Outcome data as reported by the Bayley Scales were combined for infants assessed at 1 year of age, revealing a weighted mean Mental Development Index of 90.3 (95% confidence interval: 88.9-91.6) and Psychomotor Development Index of 78.1 (95% confidence interval: 76.4-79.7). Additional analysis was limited by a lack of data at pre-school and school age. CONCLUSIONS: With this review we identified a limited number of pro-spective studies that systematically addressed outcome in patients at the highest risk. These studies consistently revealed cognitive and mo-tor delay in children after cardiac surgery during early infancy. Addi-tional investigation is required to ascertain the consequences of such impairment during later childhood and into adult life.

Original languageEnglish
Pages (from-to)e818-e827
Number of pages12
Issue number4
Publication statusPublished - Apr 2010
Externally publishedYes


  • Brain injury
  • Cardiac surgery
  • Congenital heart defects
  • Developmental disabilities

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