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A predictive model for neurodevelopmental outcome after the Norwood procedure
William T Mahle1, Minmin Lu, Richard G Ohye
1Children's Healthcare of Atlanta and Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322, USA. MahleW@kidsheart.com
Pediatric Cardiology
|August 7, 2012
Summary
Identifying infants at high risk for neurodevelopmental impairment after the Norwood procedure is crucial. A model using readily available clinical data can predict poor outcomes, guiding early intervention for single right ventricle lesions.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Congenital Heart Disease Surgery
Background:
- The Norwood procedure is a critical intervention for single right ventricle (SRV) lesions.
- Neurodevelopmental outcomes in infants undergoing the Norwood procedure are often suboptimal compared to the general population.
- Early identification of infants at risk for neurodevelopmental impairment (NDI) post-Norwood is essential for timely intervention.
Purpose of the Study:
- To develop and validate a predictive model for severe neurodevelopmental impairment in infants after the Norwood procedure.
- To utilize variables readily available at hospital discharge for risk stratification.
- To improve clinical decision-making and resource allocation for post-Norwood care.
Main Methods:
- A classification and regression tree (CART) model was developed using data from the Single-Ventricle Reconstruction (SVR) trial.
- The model predicted severe NDI, defined as a Psychomotor Development Index (PDI) score < 70 on the Bayley Scales of Infant Development-II.
- Model validation was performed using data from the Infant Single Ventricle (ISV) trial.
Main Results:
- A significant proportion of infants (44%) exhibited severe NDI (PDI < 70).
- Key predictors of poor neurodevelopmental outcome included prolonged post-Norwood intensive care unit (ICU) stay (>46 days), genetic syndromes/anomalies, low birth weight (<2.7 kg), additional cardiac surgeries, and polypharmacy at discharge.
- The CART model achieved 75% accuracy in identifying affected infants in the SVR trial and 67% in the ISV trial.
Conclusions:
- A predictive model incorporating variables from the Norwood hospitalization can identify infants at elevated risk for NDI.
- Despite the model's utility, a substantial number of severely affected infants may not be identified, underscoring the need for universal surveillance.
- Close monitoring and early intervention services are recommended for all infants following the Norwood procedure due to the high prevalence of NDI.
