Neurodevelopmental Outcomes After Cardiac Surgery in Infancy | Journal Scan

Study Questions:

What are the neurodevelopmental outcomes for infants undergoing neonatal cardiac surgery?

Methods:

The study made use of existing individual participant data from previous studies reporting neurodevelopmental outcomes after cardiac surgery in infancy between 1996 and 2009. Studies using the Bayley Scales of Infant Development, second edition (BSID-II), were included. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI).

Results:

A total of 1,770 subjects from 22 institutions were assessed at a mean age of 14.5 ± 3.7 months. PDI (77.6 ± 18.8) and MDI (88.2 ± 16.7) were lower than normative means (p < 0.001). After adjustment for center and type of congenital heart disease, later year of birth was not significantly associated with higher PDI or MDI. Risk factors for lower PDI were lower birth weight, white race, and presence of a genetic/extracardiac anomaly. After adjustment for these factors, PDIs improved over time (0.39 points per year, 95% confidence interval [CI], 0.01-0.78; p = 0.045). Risk factors for lower MDI were lower birth weight, male gender, lower level of maternal education, and presence of a genetic/extracardiac anomaly. After adjustment for these factors, MDIs improved over time (0.38 points per year, 95% CI, 0.05-0.71; p = 0.02).

Conclusions:

Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved over time, but only after adjustment for patient risk factors.

Perspective:

Although not a formal meta-analysis, this study pooled existing data of BSID-II results from 22 international centers. The results are sobering, particularly in the realm of psychomotor development. Although there was some improvement over the 13-year time course of the study, it became apparent only after adjustment for innate patient factors. This is reflective of increased complexity and risk of patients undergoing cardiac surgery in the latter portion of the study. Further work is necessary in identifying modifiable risk factors and optimizing neurodevelopmental outcomes for the entire population of infants undergoing complex interventions. As patients increase in number and complexity, there will be an associated increased requirement for societal resources.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Interventions, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Birth Weight, Cardiac Surgical Procedures, Child, Child Development, Genetic Diseases, X-Linked, Heart Defects, Congenital, Infant, Outcome Assessment (Health Care), Pediatrics, Risk, Risk Assessment, Risk Factors, Survivors


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