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Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy
  1. Julia K Gunn1,2,3,
  2. John Beca4,
  3. Rodney W Hunt1,2,3,
  4. Michelle Goldsworthy5,
  5. Christian P Brizard6,
  6. Kirsten Finucane7,
  7. Susan Donath3,8,
  8. Lara S Shekerdemian5
  1. 1Newborn Intensive Care, The Royal Children's Hospital, Melbourne, Australia
  2. 2Neonatal Research Group, Murdoch Children's Research Institute, Melbourne, Australia
  3. 3Department of Paediatrics, The University of Melbourne, Australia
  4. 4Department of Paediatric Intensive Care, Starship Children's Hospital, Auckland, New Zealand
  5. 5Department of Pediatric Critical Care, Texas Children's Hospital, Houston, Texas, USA
  6. 6Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
  7. 7Department of Cardiac Surgery, Starship Children's Hospital, Auckland, New Zealand
  8. 8Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
  1. Correspondence to Professor Lara Shekerdemian, Pediatric Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, WT6-006, Houston, TX 77030, USA; lssheker{at}texaschildrens.org

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 2 years 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 2 months 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 2 years, survivors were assessed using the Bayley Scales of Infant Development-III.

Results At 2 years, 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.

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

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Footnotes

  • Contributors JKG was responsible for collection, analysis and interpretation of data and drafting and revision of the manuscript. JB participated in the concept and study design and was responsible for collection, analysis and interpretation of data and revision of the manuscript. RWH and SD were responsible for analysis and interpretation of data and revision of the manuscript. MG was responsible for collection and analysis of data and revision of the manuscript. CPB and KF were responsible for collection and interpretation of data and revision of the manuscript. LSS participated in the concept and study design and was responsible for analysis and interpretation of data and revision of the manuscript.

  • Funding The study was supported from the National Heart Foundation (Australia), Heart Foundation of New Zealand, Auckland Medical Research Fund, Green Lane Research and Education Fund, Australian and New Zealand Intensive Care Foundation, MCRI and the Victorian Government's Operational Infrastructure Support Program. Dr Gunn received a Career Development Award from MCRI. The study sponsors played no role in the research nor production of this manuscript.

  • Competing interests None declared.

  • Ethics approval Royal Children's Hospital and Starship Children's Hospital Human Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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