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Updated: Mar 1, 2026
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery
Miranda Campbell1,2, Bridgette Rabbidge2, Jenny Ziviani2,3
1Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.
Insights
Pre-operative neurodevelopmental assessment is often not feasible for infants with congenital heart disease undergoing open heart surgery due to medical instability. The Aristotle score may help identify at-risk infants for developmental surveillance.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Neonatal Surgery
Background:
- Infants with congenital heart disease (CHD) are at increased risk for neurodevelopmental delays.
- Early neurodevelopmental assessment before surgery can identify high-risk infants.
- Clinical feasibility of pre-operative assessment in this population is not well-established.
Purpose of the Study:
- To investigate factors affecting the clinical feasibility of pre-operative neurodevelopmental assessment.
- To identify predictors of successful assessment in infants undergoing early open heart surgery.
Main Methods:
- Cross-sectional study of infants (<4 months) undergoing open heart surgery.
- Utilized Test of Infant Motor Performance and Prechtl's Assessment of General Movements pre-operatively.
- Recorded reasons for failed assessments (infant or environmental factors).
- Compared demographic data and Aristotle scores; used logistic regression.
Main Results:
- 62% of 60 infants could not complete pre-operative assessment.
- Infant-related medical instability (40%) was the primary barrier.
- Higher Aristotle Patient-Adjusted Complexity scores correlated with increased likelihood of failed assessment (OR 1.35).
Conclusions:
- Pre-operative neurodevelopmental assessment is frequently not feasible in infants undergoing open heart surgery.
- Medical instability is the main reason for assessment failure.
- The Aristotle score may help guide developmental surveillance for this vulnerable group.
Aim:
Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery.
Methods:
Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations.
Results:
A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03).
Conclusion:
Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort.
