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 .
Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy
Objective Historical 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 aim ed to determine perioperative risk factors for impaired neurodevelopment at 2 years following surgery for congenital heart disease ( CHD ) in early infancy . Design and patients We undertook a prospect i ve 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 measures Predefined 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 . Results At 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 . Conclusions In the modern era of infant cardiac surgery and perioperative care , children continue to demonstrate neurodevelopmental delays . The use of up date d assessment tools has revealed early language dysfunction and relative sparing of motor function . Ongoing follow-up is critical in this high-risk population
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 .