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Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5-Year Neurocognitive Outcomes
Naveen Sidhu1, Ari R Joffe1, Paul Doughty2
1Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada (N.S., A.R.J.).
Insights
Infants undergoing congenital heart disease surgery may experience long-term neurocognitive deficits following sepsis. Preventing sepsis and improving care, especially with extracorporeal membrane oxygenation, can enhance cognitive outcomes.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Outcomes
- Critical Care Medicine
Background:
- Congenital heart disease (CHD) surgery in infancy can impact long-term neurocognitive development.
- The association between perioperative sepsis and neurocognitive outcomes remains an area of investigation.
Purpose of the Study:
- To determine if sepsis is linked to neurocognitive outcomes 4.5 years after early infancy surgery for congenital heart disease.
- To analyze the impact of perioperative sepsis and extracorporeal membrane oxygenation (ECMO) on neurocognitive development.
Main Methods:
- Secondary analysis of a prospective inception cohort of infants undergoing CHD surgery with cardiopulmonary bypass.
- Neurocognitive outcomes assessed at 4.5 years using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI).
- Multivariable regression models used to analyze associations between sepsis, ECMO, and neurocognitive outcomes, and mortality.
Main Results:
- Sepsis occurred in 19% of patients; 18% experienced mortality by 4.5 years.
- Extracorporeal membrane oxygenation (ECMO) was significantly associated with worse neurocognitive scores (e.g., -13.6 for full-scale IQ).
- Perioperative sepsis was associated with lower performance and verbal IQ scores (e.g., -5.31 for performance IQ), with a trend for full-scale IQ.
Conclusions:
- Perioperative sepsis and ECMO are associated with adverse neurocognitive outcomes in children after CHD surgery.
- Quality improvement initiatives focused on sepsis prevention may improve long-term neurocognitive function in this vulnerable population.
Background:
We aimed to determine whether sepsis is associated with neurocognitive outcomes 4.5 years after congenital heart disease surgery in early infancy.
Methods And Results:
A secondary analysis from a prospective inception cohort included all children having congenital heart disease surgery done at ≤6 weeks of age with cardiopulmonary bypass at the Western Canadian referral center from 1996 to 2009. Follow-up at the referral center determined the primary outcomes at 4.5 years with full-scale, performance, and verbal intelligence quotients on the Wechsler Preschool and Primary Scale of Intelligence. Perioperative variables were collected prospectively, and confirmation of blood culture-positive sepsis was done retrospectively. Multiple linear regression models for neurocognitive outcomes and multiple Cox proportional hazards regression for mortality were determined. Sepsis occurred in 97 of 502 patients (19%) overall and in 76 of 396 survivors (19%) with 4.5-year follow-up. By 4.5 years, there were 91 (18%) deaths, and 396 of 411 survivors (96%) had follow-up completed. Extracorporeal membrane oxygenation was associated with worse scores on all neurocognitive outcomes on multivariable regression; the association between extracorporeal membrane oxygenation and full-scale intelligence quotient had a regression coefficient of -13.6 (95% CI -21.3 to -5.9; P=0.001). Sepsis perioperatively was associated with performance and verbal intelligence quotients, with a trend for full-scale intelligence quotient (P=0.058) on multivariable regression. The regression coefficient for sepsis was strongest for performance intelligence quotient (-5.31; 95% CI -9.84 to -0.78; P=0.022). Sepsis was not but extracorporeal membrane oxygenation was associated with mortality by 4.5 years.
Conclusions:
Perioperative sepsis and extracorporeal membrane oxygenation were associated with adverse neurocognitive outcomes on multivariable regression. Quality improvement to prevent sepsis has the potential to improve long-term neurocognitive outcomes in infants after surgery for congenital heart disease.
