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Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects
Catherine Limperopoulos1, Annette Majnemer, Michael I Shevell
1School of Physical and Occupational Therapy, Departments of Neurology and Neurosurgery, McGill University-Montreal Children's Hospital, Québec, Canada.
Insights
Congenital heart defects often lead to developmental delays in children post-surgery. Factors like brain injury and surgery specifics increase the risk of these persistent deficits.
Area of Science:
- Pediatric Cardiology
- Developmental Neuroscience
- Pediatric Surgery
Background:
- Congenital heart defects (CHDs) are common birth abnormalities requiring surgical intervention.
- Developmental impairments can persist in children following surgical correction of CHDs.
Purpose of the Study:
- To determine the prevalence of persistent developmental impairments in children with CHDs.
- To identify risk factors associated with adverse neurodevelopmental outcomes after heart surgery.
Main Methods:
- Prospective recruitment of 131 infants under 2 years old undergoing open-heart surgery.
- Standardized developmental assessments and neurologic examinations at surgery and 12-18 months post-surgery.
Main Results:
- 41% of children exhibited abnormal neurologic examinations at follow-up.
- 42% had motor delays, and 23% showed global developmental delay.
- Risk factors included preoperative/postoperative neurodevelopmental status, microcephaly, heart lesion type, circulatory arrest duration, age at surgery, and ICU stay.
Conclusions:
- Children with CHDs frequently experience ongoing neurologic, motor, and developmental deficits post-surgery.
- These deficits result from multifactorial causes, including brain injury occurring before, during, and after cardiac surgery.
Objectives:
To determine the prevalence of persistent developmental impairments in children with congenital heart defects and to identify factors that enhance risk for an adverse outcome.
Study Design:
Eligible infants (n = 131) <2 years of age requiring open heart surgery were recruited prospectively. Subjects were assessed during surgery and again 12 to 18 months later with standardized developmental assessments and formal neurologic examinations.
Results:
Mean age at follow-up testing was 19.1 +/- 6.6 months. Assessments indicated that 41% had abnormal neurologic examinations. Gross and/or fine motor delays were documented in 42%, and 23% demonstrated global developmental delay. Univariate and multiple regression models identified the following factors increasing the risk for persistent developmental deficits: preoperative and acute postoperative neurodevelopmental status and microcephaly, type of heart lesion, length of deep hypothermic circulatory arrest, age at surgery, and days in the intensive care unit (P <.05).
Conclusions:
Children with congenital heart defects commonly have ongoing neurologic, motor, and developmental deficits well after surgical correction. The cause is multifactorial and includes brain injury before, during, and after heart surgery.
