Related Experiment Video
Updated: Apr 14, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Clinical Outcome Score Predicts Adverse Neurodevelopmental Outcome After Infant Heart Surgery
Andrew S Mackie1, Shabnam Vatanpour2, Gwen Y Alton3
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
Insights
A clinical outcome score derived from early postoperative events in infants undergoing heart surgery is linked to lower neurodevelopmental scores. Scores of 4 or greater indicate a higher risk for poorer cognitive, language, and motor outcomes at 18-24 months.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Developmental Neuroscience
Background:
- Infants undergoing cardiopulmonary bypass surgery face risks of neurodevelopmental deficits.
- Early postoperative events may predict long-term outcomes.
Purpose of the Study:
- To investigate the association between an early clinical outcome score and Bayley-III neurodevelopmental scores at 18-24 months.
- To assess the predictive value of postoperative recovery for infant neurodevelopment after cardiac surgery.
Main Methods:
- Infants (≤6 weeks) undergoing cardiopulmonary bypass surgery (2005-2009) were evaluated.
- A clinical outcome score (0-7) based on early postoperative events was calculated; lower scores indicated faster recovery.
- Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) assessed neurodevelopment at 18-24 months.
Main Results:
- A clinical outcome score of 4 or greater was associated with significantly lower Bayley-III cognitive, language, and motor scores.
- Infants with higher clinical outcome scores showed delayed normalization of lactate levels and increased inotrope requirements.
- The Norwood group had a higher mean clinical outcome score compared to the arterial switch and total anomalous pulmonary venous connection groups.
Conclusions:
- A clinical outcome score of 4 or greater in infants after cardiopulmonary bypass surgery predicts lower neurodevelopmental outcomes.
- This score may serve as a valuable endpoint for evaluating new therapies in high-risk infant populations.
Background:
The purpose of this study was to determine whether a clinical outcome score derived from early postoperative events is associated with Bayley-III scores at 18 to 24 months among infants undergoing cardiopulmonary bypass surgery.
Methods:
Included were infants aged 6 weeks or less who underwent surgery between 2005 and 2009, all of whom were referred for neurodevelopmental evaluation at 18 to 24 months. We excluded children with chromosomal abnormalities. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal life support were assigned a score of 7.
Results:
One hundred and ninety-nine subjects were included. Surgical procedures were arterial switch (72), Norwood (60), repair of total anomalous pulmonary venous connection (29), and other (38). Nine subjects had postoperative extracorporeal life support. Mean clinical outcome score in the Norwood group was 4.0 ± 1.4 versus the arterial switch group (2.6 ± 1.5, p < 0.001), total anomalous pulmonary venous connection group (2.8 ± 1.8, p < 0.01), and other group (4.0 ± 1.8, p = not significant). Among children who had a clinical outcome score of 4 or greater, there was a decrease in Bayley-III cognitive score of 5.7 (95% confidence interval: 1.5 to 9.9, p = 0.009), a decrease in language score of 10.0 (95% confidence interval: 4.9 to 15.1, p < 0.001), and a decrease in motor score of 9.7 (95% confidence interval: 4.8 to 14.5, p < 0.001). Time until lactate of 2.0 mmol/L or less and highest 24-hour inotrope score increased with increasing clinical outcome score (p < 0.0001).
Conclusions:
Clinical outcome scores of 4 or greater were associated with significantly lower Bayley-III scores at 18 to 24 months. This score may be valuable as an endpoint when evaluating novel potential therapies for this high-risk population.
