Associations Between Postoperative Management in the Critical Care Unit and Adolescent Developmental Outcomes Following Cardiac Surgery in Infancy: An Exploratory Study
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Published on: May 26, 2023
Allison H Shevell1,2, Sossy K Sahakian3, Quynh Nguyen3
1Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Postoperative critical care in the pediatric intensive care unit (PICU) after heart surgery impacts adolescent neurodevelopment. Longer ventilation and dopamine use were linked to poorer motor and cognitive outcomes in children with congenital heart disease.
Area of Science:
- Pediatric critical care medicine
- Pediatric cardiology
- Neurodevelopmental outcomes
Background:
- Children with congenital heart disease (CHD) face significant risks for developmental issues.
- Research often overlooks the impact of the postoperative period on long-term neurodevelopmental outcomes.
- This study investigates the link between postoperative pediatric intensive care unit (PICU) factors and adolescent neurodevelopment in CHD patients.
Purpose of the Study:
- To examine the relationship between patient-related factors during the postoperative PICU course following cardiac surgery and long-term neurodevelopmental outcomes in adolescence.
- To identify specific PICU variables associated with impaired neurodevelopmental trajectories in children with CHD.
Main Methods:
- A retrospective chart review was conducted on 80 adolescents with CHD who underwent open-heart surgery before age two.
- Data on postoperative PICU course variables (e.g., ventilation duration, medication use, length of stay) were collected.
- Neurodevelopmental outcomes were assessed using standardized tests for motor, cognitive, and behavioral functions.
Main Results:
- Longer mechanical ventilation and dopamine use were associated with lower motor scores.
- Dopamine use correlated with lower cognitive scores.
- Extended PICU stay, open chest, longer inotropic support, delayed enteral feeding, lower hemoglobin, and higher creatinine were linked to increased behavioral difficulties.
Conclusions:
- Postoperative PICU course factors significantly influence long-term neurodevelopmental outcomes in adolescents with CHD.
- Findings highlight critical care management strategies that may mitigate adverse neurodevelopmental sequelae.
- This research can inform targeted interventions to improve long-term outcomes for pediatric cardiac surgery patients.
Objectives:
Children with congenital heart disease are at high risk for developmental sequelae. Most studies focus on preoperative and intraoperative predictors of developmental impairment, with less attention to the postoperative period. The relationship between patient-related factors specific to the postoperative course in the PICU following cardiac surgery with long-term neurodevelopmental outcomes in adolescence was examined.
Design:
Retrospective chart review of patients previously recruited to a study describing their developmental outcomes in adolescence.
Setting:
Single tertiary care pediatric hospital in Canada.
Patients:
Eighty adolescents, born between 1991 and 1999, with congenital heart disease who required open-heart surgery before 2 years old.
Measurements And Main Results:
Several variables related to acuity of illness and complexity of postoperative course in the PICU were collected. Outcome measures included the Movement-Assessment Battery for Children-2 (motor), Leiter Brief Intelligence Quotient (cognition), and Strength and Difficulties Questionnaire (behavior). Analyses examined associations between PICU variables and long-term outcomes. Longer mechanical ventilation (β = -0.49; p = 0.013) and dopamine use (β = -14.41; p = 0.012) were associated with lower motor scores. Dopamine use was associated with lower cognitive scores (β = -14.02; p = 0.027). Longer PICU stay (β = 0.18; p = 0.002), having an open chest postoperatively (β = 3.83; p = 0.017), longer mechanical ventilation (β = 0.20; p = 0.001), longer inotrope support (β = 0.27; p = 0.002), hours on dopamine (β = 0.01; p = 0.007), days to enteral feeding (β = 0.22; p = 0.012), lower hemoglobin (β = -0.11; p = 0.004), and higher creatinine (β = 0.05; p = 0.014) were all associated with behavioral difficulties.
Conclusions:
Several important developmental outcomes in adolescents were associated with factors related to their postoperative course in the PICU as infants. Findings may highlight those children at highest risk for neurodevelopmental sequelae and suggest new approaches to critical care management following open-heart surgery, with the aim of mitigating or preventing adverse long-term outcomes.
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