Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy

Julia K. Gunn, John Beca, Rodney W. Hunt, Michelle Goldsworthy, Christian P. Brizard, Kirsten Finucane, Susan Donath, Lara S. Shekerdemian

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68 Citations (Scopus)

Abstract

Objective Historical cohort studies have reported adverse neurodevelopment following cardiac surgery during early infancy. Advances in surgical techniques and perioperative care have coincided with updating of neurodevelopmental assessment tools. We aimed to determine perioperative risk factors for impaired neurodevelopment at 2years following surgery for congenital heart disease (CHD) in early infancy. Design and patients We undertook a prospective longitudinal study of 153 full-term infants undergoing surgery for CHD before 2months of age. Infants were excluded if they had a genetic syndrome associated with neurodevelopmental impairment. Outcome measures Predefined perioperative parameters were recorded and infants were classified according to cardiac anatomy. At 2years, survivors were assessed using the Bayley Scales of Infant Development-III. Results At 2years, 130 children (98% of survivors) were assessed. Mean cognitive, language and motor scores were 93.4±13.6, 93.6±16.1 and 96.8±12.5 respectively (100±15 norm). Twenty (13%) died and 12 (9%) survivors had severe impairment (score <70), mostly language (8%). The lowest scores were in infants born with single ventricle physiology with obstruction to the pulmonary circulation who required a neonatal systemic-to-pulmonary artery shunt. Additional risk factors for impairment included reduced gestational age, postoperative elevation of lactate or S100B and repeat cardiac surgery. Conclusions In the modern era of infant cardiac surgery and perioperative care, children continue to demonstrate neurodevelopmental delays. The use of updated assessment tools has revealed early language dysfunction and relative sparing of motor function. Ongoing follow-up is critical in this high-risk population.

Original languageEnglish
Pages (from-to)1010-1016
Number of pages7
JournalArchives of Disease in Childhood
Volume101
Issue number11
DOIs
Publication statusPublished - Nov 2016
Externally publishedYes

Keywords

  • Cardiac Surgery
  • Intensive Care
  • Neonatology
  • Neurodevelopment
  • Outcomes research

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