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 .
Risk factors for preoperative periventricular leukomalacia in term neonates with hypoplastic left heart syndrome are patient related.
BACKGROUND Preoperative brain injury is common in neonates with complex congenital heart disease . Increasing evidence suggests a complex interaction of prenatal and postnatal risk factors for development of brain white matter injury , called periventricular leukomalacia ( PVL ) , in neonates with complex congenital heart disease . To date , there remains a limited underst and ing of the risk factors contributing to preoperative PVL in hypoplastic left heart syndrome ( HLHS ) . METHODS Neonates with HLHS or HLHS variants from 3 prospect i ve magnetic resonance imaging studies ( 2003 - 2010 ) were selected for this cohort . Preoperative brain magnetic resonance imaging was performed the morning of the surgery . Stepwise multilogistic regression of patient characteristics , mode of delivery ( cesarean section vs vaginal ) , time of diagnosis ( prenatal vs postnatal ) , HLHS subtypes , brain total maturation score , time to surgery , individual averaged daily preoperative blood gases , and complete blood cell count values was used to determine significant associations . RESULTS A total of 57 neonates with HLHS were born at 38.7 ± 2.3 weeks ; 86 % ( 49/57 ) had a prenatal diagnosis , with 31 % ( 18/57 ) delivered by cesarean section . HLHS with aortic atresia ( AA ) was common in this cohort , 71 % ( 41/57 ) . Preoperative PVL was identified in 19 % ( 11/57 ) . Male patients with AA ( P = .004 ) were at higher risk for PVL . Lower total brain maturation score was also identified as a strong predictor for preoperative PVL ( P = .005 ) . CONCLUSIONS In neonates with HLHS , nonmodifiable patient-related factors , including male sex with AA ( lack of ante grade blood flow ) and lower total brain maturation score , placed neonates at the greatest risk for preoperative white matter injury
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 .