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 .
Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery
IMPORTANCE There are no well-established noninvasive biomarkers for identifying patients at risk for poor outcome after surgery for congenital heart disease . Few studies have assessed prognostic accuracy of cerebral tissue oxygenation index ( cTOI ) measured by near infrared spectroscopy ( NIRS ) . OBJECTIVE To assess the utility of noninvasive NIRS monitoring as a predictor of outcomes after neonatal cardiac surgery through measurement of cTOI . To examine the utility of noninvasive NIRS monitoring in combination with lactate concentration and inotropic score in prediction of outcomes after neonatal cardiac surgery . DESIGN Prospect i ve longitudinal cohort study . SETTING Operating room and cardiac intensive care unit , Children 's National Heart Institute . PARTICIPANTS Seventy-five patients with complex congenital heart disease undergoing surgical repair within first month of life .  EXPOSURE Cerebral TOI , blood lactate , and inotropic scores were measured preoperative , intraoperative and up to 24 hours postoperative . MAIN OUTCOME MEASURES Postoperative mortality and neurodevelopmental outcome assessed by the Bayley Scales of Infant Development ( BSID II ) . Mental and motor scores were obtained at 6 , 15 , and 21 months . Good outcome was defined as survival and BSID mental and motor scores ≥70 points . Poor outcome was defined as death or BSID scores < 70 at most recent follow-up . RESULTS Cohort of 75 patients prospect ively followed including 40 patients with single ventricle and 35 with two ventricles . Four patients died before discharge and ten died within 21 months . Seven patients were lost to follow-up . Among survivors with follow-up ( n = 54 ) , BSID was abnormal in 25 ( 46 % ) . Patients with poor outcome ( n = 39 ) had lower mean cTOI 60 minutes off-CPB ( 48 % vs. 58 % , P = .003 ) and 24 hours postoperative ( 49 % vs. 59 % , P < .001 ) , higher lactate ( 8.2 vs. 5.0 mmol/L , P = .005 ) and higher inotropic scores ( 10 vs. 6 , P = .02 ) at 24 hours postoperative . ROC analysis indicated that cTOI had moderate predictive accuracy of outcome ( AUC = 0.751 , P < .001 ) . Multivariable regression analysis confirmed that predictive accuracy was improved using both cTOI and lactate at 24 hours postoperative ( AUC = 0.813 , 95 % CI : 0.705 - 0.921 , P < .001 ) with optimal cutoff values < 58 % and > 7.4 mmol/L , respectively ( sensitivity = 95 % ) . CONCLUSION Cerebral TOI combined with lactate at 24 hours postoperative are accurate non-invasive predictive biomarkers of patient survival and neurodevelopmental outcome in neonates with CHD undergoing cardiac surgery
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 .