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 .
Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5-Year Neurocognitive Outcomes
Background We aim ed to determine whether sepsis is associated with neurocognitive outcomes 4.5 years after congenital heart disease surgery in early infancy . Methods and Results A secondary analysis from a prospect i ve inception cohort included all children having congenital heart disease surgery done at ≤6 weeks of age with cardiopulmonary bypass at the Western Canadian referral center from 1996 to 2009 . Follow-up at the referral center determined the primary outcomes at 4.5 years with full-scale , performance , and verbal intelligence quotients on the Wechsler Preschool and Primary Scale of Intelligence . Perioperative variables were collected prospect ively , and confirmation of blood culture – positive sepsis was done retrospectively . Multiple linear regression models for neurocognitive outcomes and multiple Cox proportional hazards regression for mortality were determined . Sepsis occurred in 97 of 502 patients ( 19 % ) overall and in 76 of 396 survivors ( 19 % ) with 4.5-year follow-up . By 4.5 years , there were 91 ( 18 % ) deaths , and 396 of 411 survivors ( 96 % ) had follow-up completed . Extracorporeal membrane oxygenation was associated with worse scores on all neurocognitive outcomes on multivariable regression ; the association between extracorporeal membrane oxygenation and full-scale intelligence quotient had a regression coefficient of −13.6 ( 95 % CI −21.3 to −5.9 ; P = 0.001 ) . Sepsis perioperatively was associated with performance and verbal intelligence quotients , with a trend for full-scale intelligence quotient ( P = 0.058 ) on multivariable regression . The regression coefficient for sepsis was strongest for performance intelligence quotient ( −5.31 ; 95 % CI −9.84 to −0.78 ; P = 0.022 ) . Sepsis was not but extracorporeal membrane oxygenation was associated with mortality by 4.5 years . Conclusions Perioperative sepsis and extracorporeal membrane oxygenation were associated with adverse neurocognitive outcomes on multivariable regression . Quality improvement to prevent sepsis has the potential to improve long-term neurocognitive outcomes in infants after surgery for congenital heart disease
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 .