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 .
Neurodevelopmental outcome following exposure to sedative and analgesic drugs for complex cardiac surgery in infancy.
OBJECTIVES / AIM To determine whether sedation/analgesia drugs used before , during , and after infant cardiac surgery are associated with neurodevelopmental outcome . BACKGROUND Animal models suggest detrimental effects of anesthetic drugs on the developing brain . Whether these results can be extrapolated to human neonates is unclear . METHODS / MATERIAL S This is a prospect i ve follow-up project conducted in Western Canada . In all infants ≤6 weeks of age having surgery for congenital heart disease between April 2003 and December 2006 , demographic and perioperative variables were collected prospect ively .  Sedation/analgesia variables were collected retrospectively . For each drug class ( inhalationals , opioids , benzodiazepines , ketamine , and chloral hydrate ) , we calculated the cumulative dose received during hospitalization , average dose received per day , and cumulative number of days the patient received the drug . The outcomes at 18 - 24 months were as follows : General Adaptive Composite and motor scaled scores of the Adaptive Behavior Assessment System , significant mental , motor , and vocabulary delay . Multivariable logistic and linear regression was used to analyze the data . RESULTS One hundred and thirty-five neonates underwent open heart surgery ; 19 died , 16 had chromosomal abnormality , and five were lost to follow up , leaving 95 survivors for analysis . Multiple linear regression analysis found no evidence of an association between sedation/analgesia variables and ABAS-GAC score or motor scale score . Multiple logistic regression analysis found no evidence of an association between sedation/analgesia variables and significant mental , motor , or vocabulary delay . CONCLUSION We found no evidence of an association between dose and duration of sedation/analgesia drugs during the operative and perioperative period and adverse neurodevelopmental outcomes
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 .