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 .
Structural cerebral abnormalities and neurodevelopmental status in single ventricle congenital heart disease before Fontan procedure
Objectives Neonates with single ventricle congenital heart disease are at risk for structural cerebral abnormalities . Little is known about the further evolution of cerebral abnormalities until Fontan procedure . Methods Between August 2012 and July 2015 , we conducted a prospect i ve cross-sectional two centre study using cerebral magnetic resonance imaging ( MRI ) and neuro-developmental outcome assessed by the Bayley-III . Forty-seven children ( 31 male ) were evaluated at a mean age of 25.9 ± 3.4 months with hypoplastic left heart syndrome ( 25 ) or other single ventricle ( 22 ) . Results  Cerebral MRI  was abnormal in 17 patients ( 36.2 % ) including liquor space enlargements ( 10 ) , small grey ( 9 ) and minimal white ( 5 ) matter injuries . Eight of 17 individuals had combined lesions . Median ( range ) cognitive composite score ( CCS ) ( 100 , 65 - 120 ) and motor composite score ( MCS ) ( 97 , 55 - 124 ) were comparable to the reference data , while language composite score ( LCS ) ( 97 , 68 - 124 ) was significantly lower ( P = 0.040 ) . Liquor space enlargement was associated with poorer performance on all Bayley-III subscores ( CCS : P = 0.02 ; LCS : P = 0.002 ; MCS : P = 0.013 ) . The number of re-operations [ odds ratio ( OR ) 2.2 , 95 % confidence interval ( CI ) 1.1 - 4.3 ] ( P = 0.03 ) and re- interventions ( OR 2.1 , 95 % CI 1.1 - 3.8 ) ( P = 0.03 ) was associated with a higher rate of overall MRI abnormalities . Conclusions Cerebral MRI abnormalities occur in more than one third of children with single ventricle , while the neuro-developmental status is less severely affected before Fontan procedure . Liquor space enlargement is the predominant MRI finding associated with poorer neuro-developmental status , warranting further studies to determine aetiology and further evolution until school-age
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 .