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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy
Julia K Gunn1,2,3, John Beca4, Rodney W Hunt1,2,3
1Newborn Intensive Care, The Royal Children's Hospital, Melbourne, Australia.
Insights
Children undergoing infant cardiac surgery for congenital heart disease (CHD) show neurodevelopmental delays, particularly in language. Risk factors include specific heart conditions, prematurity, and repeat surgeries, highlighting the need for ongoing follow-up.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Pediatric Cardiac Surgery
Background:
- Historical studies indicate adverse neurodevelopmental outcomes after infant cardiac surgery.
- Advances in surgical techniques and perioperative care necessitate updated neurodevelopmental assessments.
Purpose of the Study:
- To identify perioperative risk factors associated with impaired neurodevelopment at two years of age in infants undergoing surgery for congenital heart disease (CHD).
Main Methods:
- Prospective longitudinal study of 153 infants undergoing CHD surgery before two months of age.
- Exclusion of infants with genetic syndromes affecting neurodevelopment.
- Assessment of survivors at two years using Bayley Scales of Infant Development-III.
Main Results:
- 130 children (98% of survivors) were assessed at two years.
- Mean cognitive, language, and motor scores were within the normal range, but 9% of survivors had severe impairment (score <70), primarily in language.
- Infants with single ventricle physiology requiring neonatal shunts had the lowest scores. Additional risks included lower gestational age, elevated postoperative lactate or S100B, and repeat surgeries.
Conclusions:
- Neurodevelopmental delays persist in infants undergoing cardiac surgery, even with modern care.
- Updated assessments reveal early language dysfunction with relative motor sparing.
- Close follow-up is essential for this high-risk pediatric population.
Objective:
Historical cohort studies have reported adverse neurodevelopment following cardiac surgery during early infancy. Advances in surgical techniques and perioperative care have coincided with updating of neurodevelopmental assessment tools. We aimed to determine perioperative risk factors for impaired neurodevelopment at 2 years following surgery for congenital heart disease (CHD) in early infancy.
Design And Patients:
We undertook a prospective longitudinal study of 153 full-term infants undergoing surgery for CHD before 2 months of age. Infants were excluded if they had a genetic syndrome associated with neurodevelopmental impairment.
Outcome Measures:
Predefined perioperative parameters were recorded and infants were classified according to cardiac anatomy. At 2 years, survivors were assessed using the Bayley Scales of Infant Development-III.
Results:
At 2 years, 130 children (98% of survivors) were assessed. Mean cognitive, language and motor scores were 93.4±13.6, 93.6±16.1 and 96.8±12.5 respectively (100±15 norm). Twenty (13%) died and 12 (9%) survivors had severe impairment (score <70), mostly language (8%). The lowest scores were in infants born with single ventricle physiology with obstruction to the pulmonary circulation who required a neonatal systemic-to-pulmonary artery shunt. Additional risk factors for impairment included reduced gestational age, postoperative elevation of lactate or S100B and repeat cardiac surgery.
Conclusions:
In the modern era of infant cardiac surgery and perioperative care, children continue to demonstrate neurodevelopmental delays. The use of updated assessment tools has revealed early language dysfunction and relative sparing of motor function. Ongoing follow-up is critical in this high-risk population.
