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Postoperative morbidities with infant cardiac surgery and toddlers’ neurodevelopment
  1. Julie Read1,
  2. Deborah Ridout2,
  3. Samantha Johnson3,
  4. Aparna Hoskote4,
  5. Karen Sheehan5,
  6. Paul Wellman6,
  7. Alison Jones7,
  8. Jo Wray1,
  9. Katherine Brown4
  1. 1Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Trust, London, UK
  2. 2Paediatric Epidemiology Biostatistics, University College London Institute of Child Health, London, UK
  3. 3Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4Heart and Lung Division, Great Ormond Street Hospital National Institute Health Research Biomedical Research Centre, London, UK
  5. 5Department of Paediatric Cardiology, Bristol Royal Children's Hospital, Bristol, UK
  6. 6Department of Paediatric Intensive Care, Evelina London Children's Hospital, London, UK
  7. 7Department of Paediatric Intensive Care, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Katherine Brown, Heart and Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; katherine.brown{at}gosh.nhs.uk

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.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.