Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
AIM ( 1 ) To systematic ally review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease ( CHD ) who underwent early surgery ; ( 2 ) to run a meta-regression analysis on the Bayley Scales of Infant Development , Second Edition Mental Developmental Index and Psychomotor Developmental Index ( PDI ) of infants up to 24 months and IQs of preschool-aged children to adolescents ; ( 3 ) to assess associations between perioperative risk factors and outcomes .
White matter injury in term neonates with congenital heart diseases: Topology & comparison with preterm newborns
Background : Neonates with congenital heart disease ( CHD ) are at high risk of punctate white matter injury ( WMI ) and impaired brain development . We hypothesized that WMI in CHD neonates occurs in a characteristic distribution that shares topology with preterm WMI and that lower birth gestational age ( GA ) is associated with larger WMI volume . Objective : ( 1 ) To quantitatively assess the volume and location of WMI in CHD neonates across three centres . ( 2 ) To compare the volume and spatial distribution of WMI between term CHD neonates and preterm neonates using lesion mapping . Methods : In 216 term born CHD neonates from three prospect i ve cohorts ( mean birth GA : 39 weeks ) , WMI was identified in 86 neonates ( UBC : 29 ; UCSF : 43 ; UCZ : 14 ) on pre‐ and /or post‐operative T1 weighted MRI . WMI was manually segmented and volumes were calculated . A st and ard brain template was generated . Probabilistic WMI maps ( total , pre‐ and post‐operative ) were developed in this common space . Using these maps , WMI in the term CHD neonates was compared with that in preterm neonates : 58 at early‐in‐life ( mean postmenstrual age at scan 32.2 weeks ) ; 41 at term‐equivalent age ( mean postmenstrual age at scan 40.1 weeks ) . Results : The total WMI volumes of CHD neonates across centres did not differ ( p = 0.068 ) : UBC ( median = 84.6 mm3 , IQR = 26–174.7 mm3 ) ; UCSF ( median = 104 mm3 , IQR = 44–243 mm3 ) ; UCZ ( median = 121 mm3 , IQR = 68–200.8 mm3 ) . The spatial distribution of WMI in CHD neonates showed strong concordance across centres with predilection for anterior and posterior rather than central lesions . Predominance of anterior lesions was apparent on the post‐operative WMI map relative to the pre‐operative map . Lower GA at birth predicted an increasing volume of WMI across the full cohort ( 41.1 mm3 increase of WMI per week decrease in gestational age ; 95 % CI 11.5–70.8 ; p = 0.007 ) , when accounting for centre and heart lesion . While WMI in term CHD and preterm neonates occurs most commonly in the intermediate zone/outer subventricular zone there is a paucity of central lesions in the CHD neonates relative to preterms . Conclusions : WMI in term neonates with CHD occurs in a characteristic topology . The spatial distribution of WMI in term neonates with CHD reflects the expected maturation of pre‐oligodendrocytes such that the central regions are less vulnerable than in the preterm neonates . HighlightsWe quantitatively assess the volume and location of WMI in term CHD neonates .  WMI in term CHD neonates occurs in a characteristic topology . WMI distribution reflects regional variability in pre‐oligodendrocyte maturation . Term CHD neonates exhibit less central WMI relative to that of preterm newborns . Younger birth GA predicts greater WMI volume independent of other risk
Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
AIM ( 1 ) To systematic ally review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease ( CHD ) who underwent early surgery ; ( 2 ) to run a meta-regression analysis on the Bayley Scales of Infant Development , Second Edition Mental Developmental Index and Psychomotor Developmental Index ( PDI ) of infants up to 24 months and IQs of preschool-aged children to adolescents ; ( 3 ) to assess associations between perioperative risk factors and outcomes .