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Evaluating the Prevalence of Optimal Neurodevelopmental Outcome at 4.5-Years in Children Previously on Ventricular
Shannon Oliver1, Holger Buchholz2, Darren H Freed2
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
Most children receiving a ventricular assist device (VAD) survive childhood. This study found optimal neurodevelopment in one-third of pediatric VAD recipients, with female sex and later implant dates being protective factors.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Medical Device Technology
Background:
- Ventricular assist devices (VADs) are increasingly used in children, with most surviving to adulthood.
- Understanding the long-term neurodevelopmental outcomes is crucial for this growing population.
Purpose of the Study:
- To examine the neurodevelopmental trajectory in children implanted with a VAD before age 6.
- To identify factors associated with optimal versus non-optimal neurodevelopmental outcomes post-VAD.
Main Methods:
- Prospective-inception-cohort study of 74 children implanted with a VAD before age 6.
- Neurodevelopmental assessments conducted between 4.5-7 years of age.
- Optimal outcome defined by cognitive, visual-motor, and adaptive behavior scores, absence of specific comorbidities; Firth multiple regression used for analysis.
Main Results:
- Neurodevelopmental assessments were available for 48 survivors.
- Optimal neurodevelopmental outcome was observed in 33% of patients.
- Female sex (OR 8.03) and VAD implant between 2015-2020 (OR 6.59) were associated with optimal outcomes.
- Neurological insult (pre/post-VAD) was associated with non-optimal outcomes (OR 0.10).
Conclusions:
- One-third of pediatric VAD recipients achieved optimal neurodevelopmental outcomes.
- Female sex and more recent implant dates (2015-2020) are protective factors.
- Neurological insult significantly increases the risk of non-optimal neurodevelopmental outcomes.
Background:
The majority of patients who undergo ventricular assist device (VAD) implant in childhood survive to adulthood. This study examined the neurodevelopmental trajectory post VAD and determined factors associated with non-optimal outcome.
Methods:
Patients implanted with a VAD aged < 6 years between 01/2006 and 12/2020, who underwent assessment at 4.5-7-years of age (and > 6 months post decannulation) with the Complex Pediatric Therapies Follow-up Program were included in a prospective-inception-cohort study. Optimal neurodevelopmental outcome was defined as scores of ≥ 80 on the Wechsler Preschool and Primary Scales of Intelligence, the Beery-Buktenica Developmental Test of Visual-Motor Integration and on the Adaptive Behavior Assessment System, in the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Firth multiple regression analysis was used to determine independent factors associated with non-optimal outcome.
Results:
A total of 74 patients underwent VAD implant at age < 6 years with neurodevelopmental assessments available for 48/51 patients who survived to testing. Median age at implant was 0.63 years (IQR 0.20, 2.74), 37.5% were female and 39.6% had congenital heart disease. Optimal outcome occurred in 33% of patients. Optimal outcome was associated with female sex [OR 8.03 (95% CI 1.69-56.64) p = 0.007] and implant between 2015 and 2020 [OR 6.59 (95% CI 1.42-42.62) p = 0.016]. Neurological insult sustained pre-post-VAD [OR 0.10 (95% CI 0.01-0.63) p = 0.01] was associated with a non-optimal outcome.
Conclusion:
Optimal outcome was present in one-third of patients. Protective factors were female sex and implant between 2015 and 2020. Neurological insult was associated with a non-optimal outcome.
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