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Published on: July 18, 2014
Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and
Darlene Huisenga1,2, Sacha La Bastide-Van Gemert3, Andrew Van Bergen1,4
1Department of Pediatric Rehabilitation and Development, Advocate Children's Hospital, Oak Lawn, IL, USA.
Insights
Children with single-ventricle congenital heart disease (CHD) undergoing early surgery face higher risks for adverse developmental outcomes. This systematic review highlights significant disparities in neurodevelopmental trajectories compared to those with two-ventricle CHD.
Area of Science:
- Pediatric Cardiology
- Developmental Neuroscience
- Surgical Outcomes Research
Background:
- Complex congenital heart disease (CHD) necessitates early surgical intervention in infants.
- Developmental outcomes in these children require systematic evaluation from infancy through adolescence.
- Understanding the impact of surgical timing and cardiac anatomy on neurodevelopment is critical.
Purpose of the Study:
- To systematically review developmental outcomes in children with complex CHD after early surgery.
- To conduct a meta-regression analysis of infant development scores and later IQs.
- To assess the association between perioperative factors and neurodevelopmental outcomes.
Main Methods:
- Systematic literature search (1990-2019) across major medical and psychological databases.
- Inclusion of infants with complex CHD undergoing primary surgery within the first 9 weeks of life.
- Quality assessment of included studies, focusing on risk of bias and internal validity.
Main Results:
- 185 papers met criteria; 100 analyzed in detail, revealing significant heterogeneity.
- Infants with single-ventricle CHD showed inferior outcomes (PDI: 77 vs. 88; IQ: 92 vs. 98) compared to two-ventricle CHD.
- Perioperative risk factors demonstrated inconsistent associations with developmental trajectories.
Conclusions:
- Infants with single-ventricle complex congenital heart disease undergoing early surgery are at the highest risk for adverse developmental outcomes.
- Neurodevelopmental disparities exist based on cardiac anatomy (single vs. two ventricles).
- Further research is needed to elucidate the impact of perioperative factors on long-term development.
Aim:
(1) To systematically review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease (CHD) who underwent early surgery; (2) to run a meta-regression analysis on the Bayley Scales of Infant Development, Second Edition Mental Developmental Index and Psychomotor Developmental Index (PDI) of infants up to 24 months and IQs of preschool-aged children to adolescents; (3) to assess associations between perioperative risk factors and outcomes.
Method:
We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed.
Results:
In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single-ventricle CHD was inferior to those with two-ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative risk factors were inconsistently associated with developmental outcomes.
Interpretation:
The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes.
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