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Neurodevelopmental outcomes after open heart operations before 3 months of age
Renée Sananes1, Cedric Manlhiot, Edmond Kelly
1Labatt Family Heart Centre and Division of Neurology, Department of Paediatrics, Surgery and Critical Care Medicine, The University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. renee.sananes@sickkids.ca
Insights
Infants undergoing heart surgery with cardiopulmonary bypass (CPB) show impaired motor development two years post-operation. Congenital heart disease (CHD) complexity and surgical care impact neurodevelopmental outcomes.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Pediatric Cardiac Surgery
Background:
- Infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) face potential developmental challenges.
- Monitoring developmental progress is crucial for early intervention in this population.
Purpose of the Study:
- To monitor developmental progress in infants after cardiac surgery.
- To identify predictors of neurodevelopmental outcomes at 2 years post-operation.
Main Methods:
- Prospective enrollment of 106 infants (<3 months) undergoing cardiac operations (1999-2003).
- Formal assessments of fine and gross motor development at 8, 12, and 24 months.
- Neurodevelopmental assessment at 24 months using the Bayley Scales of Infant Development (BSID-II) Mental Development Index (MDI).
Main Results:
- Significant gross motor deficits noted at 8 months, persisting at 24 months.
- Fine motor skills declined significantly between 8 and 24 months.
- Poorer neurodevelopmental outcomes linked to univentricular anatomy, complex coarctation, surgical complexity, longer hospital stay, and postoperative complications.
Conclusions:
- Children with congenital heart disease (CHD) exhibit impaired development 2 years post-cardiac surgery.
- Developmental patterns are skill-specific and influenced by cardiac anatomy and care complexity.
Background:
The purpose of this study was to monitor developmental progress and identify predictors of developmental outcomes at 2 years after operation in infants who underwent a surgical procedure with cardiopulmonary bypass (CPB) at less than 3 months of age.
Methods:
Patients (N=131 enrolled; N=106 assessed) less than 3 months of age at the time of cardiac operation were prospectively enrolled (years 1999-2003) and assessed at 8, 12, and 24 months after operation. Patients with preexisting conditions independently associated with poor neurodevelopmental outcomes were excluded. Fine and gross motor development was formally assessed at all 3 visits, and parent ratings of development across several domains were obtained. Neurodevelopment was formally assessed at 24 months of age using the Bayley Scales of Infant Development, 2nd edition (BSID-II) Mental Development Index score (MDI).
Results:
Significant gross motor difficulties were identified at 8 months of age (p<0.001) and, although improved by the 24-month assessment, remained lower than average. Fine motor skills showed a significant decrease from 8 to 24 months of age (p=0.001). Factors associated with poorer neurodevelopmental outcome (BSID-II MDI) at 24 months after operation included a diagnosis of univentricular anatomy or complex coarctation of the aorta, higher complexity of the surgical procedure, longer duration of hospital stay, and presence of complications in the postoperative period.
Conclusions:
Children undergoing repair of congenital heart disease (CHD) still have impaired development 2 years after the operation. Observed patterns of development were specific to the skill being assessed and related to both anatomic complexity and increased complexity of care received.
