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 .
Neurologic and psycho-intellectual outcome related to structural brain imaging in adolescents and young adults after neonatal arterial switch operation for transposition of the great arteries.
OBJECTIVE We studied brain structure abnormalities in adolescents and young adults who had undergone the neonatal arterial switch operation for transposition of the great arteries and related them to the neurologic and psycho-intellectual outcomes . METHODS In a prospect i ve longitudinal study , 60 unselected adolescents and young adults who had undergone surgery with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were re-evaluated at a mean age of 16.9±1.7 years to determine their clinical neurologic status , intellectual development , and psychological condition . The results were related to population norms and anatomic structural abnormalities assessed by brain magnetic resonance imaging , with consideration of the risk factors in the preoperative and perioperative periods . RESULTS Neurologic impairment was more frequent ( 10 % ) than in the normal population . Although the average full-scale , verbal , and performance intelligence quotients were not reduced , scores>2 st and ard deviations less than the expected mean were increased . Above average scores were found for analytical thinking , but the orthography testing results were reduced . The self-rated psychological condition was better than expected . Magnetic resonance imaging demonstrated moderate or severe structural brain abnormalities in 32 % of the patients . Periventricular leukomalacia was detected in > 50 % ; its severity correlated with the grade of neurologic impairment , which correlated significantly with reduced intelligence , analytical thinking , and orthography . Preoperative acidosis and hypoxia were the only independent patient-related risk factors for neurologic dysfunction , reduced intelligence , periventricular leukomalacia , and reduced brain volume . CONCLUSIONS Despite encouraging overall neurodevelopmental outcomes , a significant minority had performances below the expected level , emphasizing the need for ongoing surveillance . Considering the high frequency of structural brain abnormalities , prospect i ve long-term studies are needed to define their prognostic value with respect to the neuropsychological outcomes in childhood and adolescence
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 .