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 .
Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age.
BACKGROUND Early identification of infants with CHD at heightened risk of developmental delays can inform surveillance priorities . This study investigated pre-operative and post-operative neuromotor performance in infants undergoing open-heart surgery , and their developmental status at 6 months of age , to identify risk factors and inform care pathways . METHODS Infants undergoing open-heart surgery before 4 months of age were recruited into a prospect i ve cohort study . Neuromotor performance was assessed pre-operatively and post-operatively using the  Test of Infant Motor Performance and Prechtl 's Assessment of General Movements .  Development was assessed at 6 months of age using the Ages and Stages Question naire third edition . Pre-operative and post-operative General Movements performance was compared using McNemar 's test and test of infant motor performance z-scores using Wilcoxon 's signed rank test . Risk factors for delayed development at 6 months were explored using logistic regression . RESULTS Sixty infants were included in this study . In the 23 ( 38 % ) infants . A total of 60 infants were recruited . In the 23 ( 38 % ) infants assessed pre-operatively , there was no significant difference between pre- and post-operative performance on the GMs ( p=0.63 ) or TIMP ( p=0.28 ) . At discharge , 15 ( 26 % ) infants presented with abnormal GMs , and the median TIMP z-score was -0.93 ( IQR : -1.4 to -0.69 ) . At 6 months , 28 ( 52.8 % ) infants presented with gross motor delay on the ASQ-3 , significantly negatively associated with gestational age ( p=0.03 ) , length of hospital stay ( p=0.04 ) and discharge TIMP score ( p=0.01 ) . CONCLUSIONS Post-operative assessment using the GMs and TIMP may be useful to identify infants requiring individualised care and targeted developmental follow-up . Long-term developmental surveillance beyond 6 months of age is recommended
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 .