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 Burden at Age 5 Years in Patients With Univentricular Heart
BACKGROUND : Despite increasing survival , patients with hypoplastic left heart syndrome ( HLHS ) and other forms of functionally univentricular heart defects ( UVHs ) remain at increased risk of long-term neurodevelopmental deficits . METHODS : A nationwide sample of 23 patients with HLHS , 13 with UVH , and 40 controls were followed prospect ively until the age of 5 years , when neurologic , neuropsychological , and motor examinations and brain MRI were performed . RESULTS : The median full-scale IQ was significantly lower in patients with HLHS ( 97 , P < .001 ) and patients with UVH ( 112 , P = .024 ) compared with controls ( 121 ) . Major neurodevelopmental impairment was found in 26 % of the patients with HLHS and 23 % of those with UVH , and minor neurologic dysfunction was found in 43 % and 46 % , respectively . MRI revealed abnormalities , mostly ischemic changes of different degrees , in 82 % of the patients with HLHS and in 56 % of those with UVH . Prominent changes were significantly associated with neurodevelopmental findings and parental reports of adaptive behavior . In linear regression , significant risk factors for a worse outcome were a history of clinical seizures in connection with the primary operation , a lower diameter of the neonatal ascending aorta , and several pre- , peri- , and postoperative factors related to the primary and bidirectional Glenn operations . CONCLUSIONS : Although median cognitive performance was within the normal range , neurodevelopmental and brain MRI abnormalities were found in the majority of the patients with UVH , and especially in those with HLHS , at preschool age . Both a narrowed ascending aorta and operation-related factors contributed to these findings
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 .