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 .
Association of hemoglobin and transfusion with outcome after operations for hypoplastic left heart.
BACKGROUND Red blood cell transfusions may or may not improve oxygen delivery to the tissues . Some studies suggest transfusion might contribute to adverse outcomes . This study investigated the association between hemoglobin concentration and transfusion with outcome in cyanotic neonates undergoing Norwood operations . METHODS Infants 6 weeks old or younger with hypoplastic left heart syndrome undergoing staged Norwood operations between September 1996 and July 2005 were included . Demographics and preoperative , operative , and postoperative variables were collected prospect ively . Hemoglobin concentration , transfusion , fluid balance , and chest tube losses were collected retrospectively . The association of variables with outcomes , including early and 2-year mortality , mental and psychomotor developmental indices at 18 to 24 months of age , and ventilator days were determined by univariate and multiple regression analyses . RESULTS Ninety-four patients had Norwood operations . Excluded were 10 requiring postoperative extracorporeal life support and 2 with chromosomal abnormalities . By multiple regression analysis , only a higher nadir hemoglobin on days 2 to 5 postoperatively was associated with higher early mortality ( odds ratio , 2.09 ; 95 % confidence interval [ CI ] , 1.14 to 3.87 ; p = 0.018 ) , and the highest preoperative dopamine dose and highest epinephrine dose on day 2 to 5 postoperatively were associated with 2-year mortality ; however , neither hemoglobin concentration nor number of transfusions were associated with mental or psychomotor developmental indices . The number of transfusions on day 2 to 5 postoperatively was associated with ventilator days in multiple variable analysis ( effect size , 1.85 ; 95 % CI , 0.33 to 3.36 ; p = 0.018 ) . CONCLUSIONS This single-center cohort study found transfusion was not associated with improved outcomes in neonates undergoing Norwood operations
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 .