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 .
Changing expectations for neurological outcomes after the neonatal arterial switch operation.
BACKGROUND Expectations for outcomes after the neonatal arterial switch operation ( ASO ) continue to change . This cohort study describes neurodevelopmental outcomes at age 12 months after neonatal ASO , and analyzes both modifiable and nonmodifiable factors for association with adverse outcomes . METHODS Patients who underwent an ASO ( n=30 ) were enrolled in a prospect i ve outcome study , with comprehensive clinical data collection during the first 12 months of life . Brain magnetic resonance imaging was done preoperatively and 7 days postoperatively , and the Bayley Scales of Infant Development III was performed at age 12 months . RESULTS Ten of 30 patients ( 33 % ) had preoperative magnetic resonance imaging injury ; 13 of 30 patients ( 43 % ) had new postoperative magnetic resonance imaging injury . Twenty patients ( 67 % ) had Bayley Scales of Infant Development III : Cognitive Composite st and ard score mean was 104.8±15.0 , Language Composite st and ard score median was 90.0 ( 25th to 75th percentile , 83 to 94 ) , and Motor Composite st and ard score mean was 92.3±14.2 . Best subsets multivariable analysis found associations between lower preoperative and intraoperative cerebral oxygen saturation , preoperative magnetic resonance imaging brain injury , total bypass time , and total midazolam dose and lower Bayley Scales of Infant Development III scores at age 12 months . CONCLUSIONS At 12 months after ASO , neurodevelopmental outcome means were within normal population ranges . The new associations reported in this study between potentially modifiable perioperative factors and outcomes require investigations in larger patient cohorts . Beyond survival , which was 100 % in this cohort , factors influencing quality of life including neurodevelopmental outcomes should be routinely investigated in studies of ASO patients
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 .