TY - JOUR
T1 - Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy
AU - Gunn, Julia K.
AU - Beca, John
AU - Hunt, Rodney W.
AU - Goldsworthy, Michelle
AU - Brizard, Christian P.
AU - Finucane, Kirsten
AU - Donath, Susan
AU - Shekerdemian, Lara S.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/11
Y1 - 2016/11
N2 - 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.
AB - 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.
KW - Cardiac Surgery
KW - Intensive Care
KW - Neonatology
KW - Neurodevelopment
KW - Outcomes research
UR - http://www.scopus.com/inward/record.url?scp=84973352618&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2015-309449
DO - 10.1136/archdischild-2015-309449
M3 - Article
C2 - 27272973
AN - SCOPUS:84973352618
SN - 0003-9888
VL - 101
SP - 1010
EP - 1016
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
IS - 11
ER -