Journal Article

Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy

Brizard, Christian P, Finucane, Kirsten, Hunt, Rodney W, Shekerdemian, Lara S, Donath, Susan, Gunn, Julia K, Goldsworthy, Michelle, Beca, John

2016

نظرة عامة

ObjectiveHistorical 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 patientsWe 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 measuresPredefined 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.ResultsAt 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.ConclusionsIn 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.

• الناشر: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• موضوع: Analysis / Babies / Brain / Cardiac Surgical Procedures - adverse effects / Cardiac Surgical Procedures - mortality / Cardiovascular disease / Cardiovascular diseases / Child, Preschool / Children & youth / Cognition Disorders - etiology / Cognition Disorders - mortality / Complications and side effects / Congenital diseases / Degeneration / Delayed Speech / Developmental Disabilities - etiology / Developmental Disabilities - mortality / Female / Gestational age / Health aspects / Heart / Heart Defects, Congenital - mortality / Heart Defects, Congenital - surgery / Heart surgery / Humans / Infant / Infant, Newborn / Infants / Injuries / Intensive care / Intraoperative Care / Longitudinal Studies / Male / Neonates / Nervous system / Neurodegenerative diseases / Outcome Measures / Perioperative care / Postoperative Complications - etiology / Postoperative Complications - mortality / Prospective Studies / Psychomotor Disorders - etiology / Psychomotor Disorders - mortality / Pulmonary arteries / Regression (Statistics) / Risk Factors / Statistical Analysis / Statistical Significance / Surgery / Toddlers / Traumatic brain injury / Veins & arteries / Young Children