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 .
Fetal cerebrovascular resistance and neonatal EEG predict 18-month neurodevelopmental outcome in infants with congenital heart disease.
OBJECTIVES The purpose of this study was to investigate early markers of risk for neurobehavioral compromise in survivors with congenital heart disease ( CHD ) . METHODS Pregnant women in whom a fetal CHD had been diagnosed before 24 weeks ' gestational age ( GA ) were enrolled in this prospect i ve pilot study for serial Doppler ultrasound assessment of the fetal middle cerebral artery ( MCA ) and umbilical arteries . The cerebral-to-placental resistance ratio ( CPR ) and MCA pulsatility index ( PI ) Z-scores for GA were calculated . After birth , subjects underwent high-density ( 128-lead ) electroencephalography ( EEG ) , and beta frequency ( 12 - 24 Hz ) b and EEG power  , a measure of local neural synchrony , was analyzed . Neurodevelopment was assessed at 18 months with the Bayley Scales of Infant Development (BSID)-III . RESULTS Thirteen subjects were enrolled : four with hypoplastic left heart syndrome ( HLHS ) , four with transposition of the great arteries ( TGA ) and five with tetralogy of Fallot ( TOF ) . Compared with subjects with normal CPR , those with CPR < 1 ( n = 7 ) had lower mean BSID cognitive scores ( 91.4 ± 4.8 vs. 99.2 ± 3.8 , P = 0.008 ) . Fetal MCA-PI Z-score also correlated with BSID cognitive score ( r = 0.589 , P = 0.03 ) as did neonatal EEG left frontal polar ( r = 0.58 , P = 0.037 ) and left frontal ( r = 0.77 , P = 0.002 ) beta power . Furthermore , fetal Doppler measures were associated with EEG power : fetuses with CPR < 1 had lower left frontal polar ( t = 2.36 , P = 0.038 ) and left frontal ( t = 2.85 , P = 0.016 ) beta power as newborns than did fetuses with normal CPR , and fetal MCA-PI Z-score correlated with neonatal EEG left frontal polar ( r = 0.596 , P = 0.04 ) and left frontal ( r = 0.598 , P = 0.04 ) beta power . CONCLUSION In fetuses with HLHS , TGA and TOF , abnormal cerebrovascular resistance predicts decreased neonatal EEG left frontal beta power and lower 18-month cognitive development scores
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 .