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Updated: May 18, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Clinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery
Andrew S Mackie1, Gwen Y Alton, Irina A Dinu
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. andrew.mackie@ualberta.ca
Insights
A clinical outcome score from early surgery events predicts neurodevelopmental outcomes in infants. Higher scores (≥3) correlate with lower Psychomotor Developmental Index (PDI) scores at 18-24 months.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Outcomes
- Clinical Outcome Measurement
Background:
- Infants undergoing cardiopulmonary bypass surgery face risks of neurodevelopmental impairment.
- Early postoperative events may offer insights into long-term neurodevelopmental trajectories.
- Assessing these early events is crucial for identifying at-risk infants.
Purpose of the Study:
- To investigate the association between an early postoperative clinical outcome score and the 18- to 24-month Psychomotor Developmental Index (PDI) in infants after cardiopulmonary bypass surgery.
Main Methods:
- Infants ≤6 weeks undergoing surgery (2002-2006) with neurodevelopmental evaluation at 18-24 months were included.
- A clinical outcome score (0-7) was derived from early postoperative events; lower scores indicated faster recovery.
- Exclusion criteria included chromosomal abnormalities, hearing loss, cerebral palsy, or Bayley III assessment.
Main Results:
- Ninety-nine infants were analyzed, with procedures including arterial switch, Norwood, and total anomalous pulmonary venous connection repair.
- Higher clinical outcome scores were observed in the Norwood group compared to arterial switch and total anomalous pulmonary venous connection groups.
- A clinical outcome score ≥3 was associated with a mean decrease of 10.9 points in PDI (P=.0005), and correlated with increased time to lactate normalization and higher inotrope scores.
Conclusions:
- Early postoperative clinical outcome scores of ≥3 are significantly associated with lower PDI scores at 18-24 months.
- This score may serve as a valuable endpoint for evaluating new therapies in high-risk infant populations.
- The findings highlight the importance of early postoperative monitoring for predicting long-term neurodevelopmental outcomes.
Objective:
Our goal was to determine if a clinical outcome score derived from early postoperative events is associated with 18- to 24-month Psychomotor Developmental Index (PDI) score among infants undergoing cardiopulmonary bypass surgery.
Methods:
We included infants aged ≤6 weeks who underwent surgery during 2002-2006, all of whom were referred for neurodevelopmental evaluation at age 18 to 24 months. We excluded children with chromosomal abnormalities, hearing loss, cerebral palsy, or a Bayley III assessment. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal membrane oxygenation were assigned a score of 7.
Results:
Ninety-nine subjects were included. Surgical procedures were arterial switch (n = 36), Norwood (n = 26), repair of total anomalous pulmonary venous connection (n = 16), and other (n = 21). Four subjects had postoperative extracorporeal membrane oxygenation. Clinical outcome scores were highest in the Norwood group (mean 4.1 ± 1.4) compared with the arterial switch group (1.9 ± 1.6) (P < .001), total anomalous pulmonary venous connection group (1.6 ± 2.0) (P < .001), and other group (3.3 ± 1.6, P = not significant). A mean decrease in PDI of 10.9 points (95% confidence interval, 4.9-16.9; P = .0005) was observed among children who had a clinical outcome score ≥3, compared with those with a clinical outcome score <3. Time until lactate ≤2.0 mmol/L increased with increasing clinical outcome score (P = .0003), as did highest 24-hour inotrope score (P < .0001).
Conclusions:
Clinical outcome scores of ≥3 were associated with a significantly lower PDI at age 18 to 24 months. This score may be valuable as an end point when evaluating novel potential therapies for this high-risk population.
