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Published on: July 18, 2014
Growth and neurodevelopment at 18-22 months in term infants with CHD undergoing cardiopulmonary bypass surgery: a
Misuzu Yoshida1, Katsuya Hirata1, Masatoshi Nozaki1
1Department of Neonatal Medicine, https://ror.org/00nx7n658Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Insights
Infants with congenital heart disease (CHD) in Japan show impaired growth and neurodevelopment after surgery, particularly those with univentricular (UV) physiology. Early surgery timing did not impact these outcomes.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Surgical Outcomes
Background:
- Infants with congenital heart disease (CHD) undergoing cardiopulmonary bypass (CPB) surgery face risks of impaired growth and neurodevelopment.
- Limited research exists on risk factors, especially the timing of initial surgical intervention, for these impairments.
Purpose of the Study:
- To investigate risk factors for growth and neurodevelopmental impairments in infants with CHD post-CPB surgery.
- To compare outcomes between univentricular (UV) and biventricular (BV) physiology and assess the impact of surgical timing.
Main Methods:
- Retrospective analysis of term singleton infants with CHD who underwent CPB surgery (2015-2021).
- Neurodevelopment assessed using the Kyoto Scale of Psychological Development at 18-22 months.
- Risk factors analyzed included CHD type (UV vs. BV), birth weight, sex, and CPB surgery timing (<28 days vs. ≥28 days).
Main Results:
- Impaired growth was observed in both UV and BV groups, with significantly lower body weights in the UV group.
- Neurodevelopmental impairment (total Developmental Quotient [DQ] < 85) affected 40.7% of children, with UV physiology being a significant risk factor (aOR 3.11).
- Timing of initial CPB surgery was not associated with growth or neurodevelopmental outcomes.
Conclusions:
- Infants with CHD in Japan experience impaired growth and neurodevelopment post-CPB surgery by 18-22 months.
- Univentricular (UV) physiology is a significant risk factor for neurodevelopmental impairment in these infants.
Background:
Infants with CHD who undergo cardiopulmonary bypass surgery are at risk of impaired growth and neurodevelopment. However, few studies have thoroughly investigated the risk factors for growth and neurodevelopmental impairments, particularly with respect to the timing of the initial surgical intervention.
Methods:
We retrospectively analysed term singleton infants with CHD who underwent cardiopulmonary bypass surgery at a Japanese tertiary centre between 2015 and 2021. Neurodevelopment was assessed at 18-22 months of age using the Kyoto Scale of Psychological Development. We compared outcomes by CHD type (univentricular [UV] vs. biventricular [BV]) and analysed risk factors for growth impairment (weight and height < tenth percentile) and neurodevelopmental impairment (developmental quotient [DQ] < 85), including birth weight, sex, the type of CHD (UV or BV), and timing of the initial cardiopulmonary bypass surgery (<28 days or ≥28 days).
Results:
Of the 108 eligible children, 29 had UV physiology and 79 had BV physiology. Both groups showed impaired growth, with significantly lower body weights in the UV group. Neurodevelopmental scores (total DQ) were significantly lower in the UV group. Neurodevelopmental impairment (total DQ < 85) was observed in 44/108 (40.7%) children, and after adjustment, UV repair was significantly associated with neurodevelopmental impairment (adjusted odds ratio [OR] 3.11, 95% confidence interval [CI] 1.27-7.65). Timing of the initial cardiopulmonary bypass surgery was not associated with outcomes.
Conclusion:
Infants with CHD in Japan exhibit impaired growth and neurodevelopment at 18-22 months following cardiopulmonary bypass surgery, especially those with UV physiology.
