Perioperative Factors Associated with 2-Year Neurodevelopmental Outcome in Neonates Undergoing Congenital Cardiac...

Advances in neonatal cardiac surgery have significantly reduced mortality rates for complex congenital heart diseases (CHD). However, long-term morbidities, particularly neurodevelopmental (NDV) outcomes, remain a concern. Perioperative factors implicated in NDV delays are less described. This study aimed to assess NDV outcomes at 2 years in a cohort of neonates undergoing cardiopulmonary bypass (CPB) and identify perioperative variables associated with non-optimal NDV. This analysis included neonates from the Loire Infant Follow-up Team (LIFT) cohort who underwent CPB between 2014 and 2021. NDV outcomes were assessed at 24 months using the Ages and Stages Questionnaire (ASQ-2) and/or expert clinical evaluations. Non-optimal NDV was defined as two or more ASQ domains below cut-off values or a clinical diagnosis of neurodevelopmental delay. Of 254 neonates operated on 84 were analyzed. Non-optimal NDV was observed in 11 patients (13.1%), while 65 (77.4%) were classified as having Optimal NDV. Motor and cognitive delays were infrequent (5%), and language delays were observed in 9.5% of cases. No association between major complication during post-operative period and non-optimal NDV was found. Maximal serum lactate levels during the first 72 postoperative hours were significantly associated with non-optimal NDV after adjusting for RACHS category (adjusted odds ratio: 1.41 per mmol/L above 2.2 mmol/L, p = 0.04). Contemporary neonatal cardiac surgery shows encouraging NDV outcomes, with achieving normal development by 2 years. Elevated postoperative lactate levels, used as a surrogate of serious events occurring during the post-operative period, were associated with non-optimal NDV, highlighting the importance of optimizing perioperative care. Larger studies with extended follow-up are needed to validate these findings and explore additional modifiable predictors of long-term outcomes.