Article Text
Abstract
Objective To evaluate the relationship between morbidities after infant cardiac surgery and neurodevelopment and behaviour at age 2–3 years.
Design/Setting A prospective cohort follow-up study, in four paediatric cardiac centres. We excluded children with known syndromes. Home-based neurodevelopmental assessments using the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) were undertaken in 81 children and secondary outcome measures of development and behaviour were completed by parents. A further 41 families completed the secondary outcome measures remotely.
Results Children were grouped as multiple morbidities/extracorporeal life support (ECLS) (n=19), single morbidities (n=36) and no morbidities (n=59). Group comparisons found that children with multiple morbidities/ECLS, compared with no morbidities, had: (a) lower adjusted mean scores for core Bayley-III composites (none reached the level of statistical significance), with mean differences of cognitive −6.1 (95% CI −12.4 to 0.1) p=0.06, language −9.1 (95% CI −18.6 to 0.3) p=0.06 and motor −4.4 (95% CI −12.0 to 3.1) p=25; (b) greater adjusted odds of at least one low or borderline Bayley-III composite result 4.0 (95% CI 1.0 to 16.0) (p=0.05); (c) greater adjusted risk of an abnormal Ages and Stages Questionnaire (ASQ) result 5.3 (95% CI 1.3 to 21.1) (p=0.03) and a borderline ASQ result 4.9 (95% CI 1.0 to 25.0) (p=0.05); and no difference in the risk of an abnormal Strengths and Difficulties Questionnaire result 1.7 (95% CI 0.3 to 10.4) p=0.58. These outcomes were not statistically different between the single morbidity and no morbidity groups.
Conclusions Children who experience multiple morbidities/ECLS after infant heart surgery are at a greater risk of neurodevelopmental difficulties than their peers who had no complications and should be prioritised for neurodevelopmental follow-up.
- cardiology
- child development
- neurology
- paediatrics
- child health services
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The data are de-identified and conditions of use would include Health Research Authority approval and Research Ethics Committee approval. For details please contact Dr Kate Brown (ORCID) 0000-0002-0729-4959.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The data are de-identified and conditions of use would include Health Research Authority approval and Research Ethics Committee approval. For details please contact Dr Kate Brown (ORCID) 0000-0002-0729-4959.
Footnotes
Twitter @AparnaHoskote, @dr_jowray
Contributors The study was designed by KB, JW, SJ and DR. Assessments were undertaken and led by JR. Clinical input was provided by AH, KS, PW, AJ and KB. The paper was written by JR, KB and DR. KB is guarantor.
Funding This study was funded by Great Ormond Street Children’s Charity (GOSHCC V0139). This project benefited from funding by the National Institute for Health Research Health Services and Delivery Research programme (Project No: 12/5005/06). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HS&DR programme or the Department of Health. We wish to thank all those who contributed to the Cardiac Impact Study from Great Ormond Street Hospital, Bristol Children’s Hospital, Evelina London Hospital, Bristol Children’s Hospital and University College London.
Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HS&DR programme or the Department of Health.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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