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Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life
M Florencia Ricci1, John C Andersen2, Ari R Joffe3
1Division of Developmental Pediatrics, Department of Pediatrics.
Insights
Chronic neuromotor disability (CND) affects 6% of children after early complex cardiac surgery (CCS). Key predictors include age at surgery and high plasma lactate levels, suggesting potential interventions to reduce CND frequency.
Area of Science:
- Pediatric Cardiology
- Neurology
- Developmental Pediatrics
Background:
- Chronic neuromotor disability (CND), including cerebral palsy and motor impairments, is poorly understood in children surviving complex cardiac surgery (CCS).
- Early complex cardiac surgery (CCS) in infants, particularly those with congenital heart defects (CHD), poses risks for neurodevelopmental outcomes.
Purpose of the Study:
- To determine the frequency and presentation of CND in children after early CCS.
- To identify modifiable acute care predictors of CND in this vulnerable population.
Main Methods:
- Prospective follow-up of 549 infants undergoing CCS at ≤6 weeks of age.
- Multidisciplinary assessment at 4.5 years for 420 survivors to evaluate CND.
- Logistic regression analysis to identify independent predictors of CND.
Main Results:
- CND occurred in 6% of survivors, with higher rates in those undergoing >1 CCS (9.8%) compared to 1 CCS (4.2%).
- Common CND presentations included hemiparesis (72%), spasticity (80%), and intellectual disability (44%).
- Independent predictors for CND were older age at first CCS, higher preoperative plasma lactate, and undergoing >1 CCS.
Conclusions:
- Chronic neuromotor disability is a significant concern for survivors of early complex cardiac surgery.
- Findings highlight the need for awareness and targeted interventions, such as optimizing preoperative lactate levels and surgical timing.
- This study provides crucial data for pediatricians managing children with complex congenital heart disease and potential neurodevelopmental challenges.
Background And Objectives:
Little is known about chronic neuromotor disability (CND) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery (CCS). We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors.
Methods:
This prospective follow-up study included 549 children after CCS requiring cardiopulmonary bypass at ≤6 weeks of age. Groups included those with only 1 CCS, mostly biventricular CHD, and those with >1 CCS, predominantly single ventricle defects. At 4.5 years of age, 420 (94.6%) children received multidisciplinary assessment. Frequency of CND is given as percentage of assessed survivors. Predictors of CND were analyzed using multiple logistic regression analysis.
Results:
CND occurred in 6% (95% confidence interval [CI] 3.7%-8.2%) of 4.5-year survivors; for 1 CCS, 4.2% (CI 2.3%-6.1%) and >1, 9.8% (CI 7%-12.6%). CND presentation showed: hemiparesis, 72%; spasticity, 80%; ambulation, 72%; intellectual disability, 44%; autism, 16%; epilepsy, 12%; permanent vision and hearing impairment, 12% and 8%, respectively. Overall, 32% of presumed causative events happened before first CCS. Independent odds ratio for CND are age (days) at first CCS, 1.08 (CI 1.04-1.12; P < .001); highest plasma lactate before first CCS (mmol/L), 1.13 (CI 1.03-1.23; P = 0.008); and >1 CCS, 3.57 (CI 1.48-8.9; P = .005).
Conclusions:
CND is not uncommon among CCS survivors. The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population. Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND.
