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 .
Mortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures.
OBJECTIVES Neonates with hypoplastic left heart syndrome ( HLHS ) are at risk of high mortality and neurodevelopmental morbidity . As an alternative to Norwood-type stage I palliation , the hybrid procedure has been developed . It consists of bilateral pulmonary artery b and ing , catheter-based stenting of the arterial duct and balloon atrioseptostomy and delays open-heart surgery . Thus , it may be associated with a better outcome . The aim of this study was to determine the mortality and neurodevelopmental outcome in patients with HLHS and other univentricular heart ( UVH ) defects treated with hybrid or Norwood procedures . METHODS Thirty-one children ( 18 males ) with HLHS and other UVH defects undergoing Norwood or hybrid procedure between 2004 and 2008 were consecutively enrolled . Mortality and neurodevelopmental outcome at 1 year of age were determined . RESULTS One-year mortality was 36 % ( 31 % in the hybrid vs. 39 % in the Norwood group , P=0.71 ) . Predictors of mortality were lower birth weight ( P=0.02 ) , older age at first procedure ( P=0.02 ) and smaller size of ascending aorta ( P=0.05 ) . Overall , median psychomotor development index ( PDI ) and mental development index ( MDI ) of the Bayley Scales of Infant Development II were lower than the norm of 100 [ PDI 57 ( 49 - 99 ) , P<0.001 ; MDI 91 ( 65 - 109 ) , P=0.002 ] . No effect of surgical treatment on neurodevelopmental outcome was found . Predictors of impaired motor outcome were length of hospital stay ( LOHS ) ( P=0.01 ) , lower body weight at second procedure ( P=0.004 ) and female sex ( P=0.01 ) . Predictors of impaired cognitive outcome were longer mechanical ventilation time ( P=0.03 ) , intensive care unit stay ( P=0.04 ) and LOHS ( P<0.001 ) , respectively . CONCLUSIONS Mortality at 1 year of age is comparable between patients undergoing hybrid and Norwood procedures . Early neurodevelopmental outcome is significantly impaired in patients with both HLHS and other UVH defects . Multicentre r and omized studies are needed to determine the long-term neurodevelopmental outcome of children treated with the hybrid procedure
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 .