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Growth and neurodevelopmental outcome of infants undergoing heart transplantation
1Department of Pediatrics, Loma Linda University School of Medicine, CA 92354.
Insights
Infants transplanted for heart conditions before six months of age generally show normal long-term growth and development. While some may experience temporary neurological issues, most achieve positive outcomes after heart transplantation.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Developmental Pediatrics
Background:
- Heart transplantation in infants is a critical intervention for end-stage heart failure.
- Understanding the long-term growth and neurodevelopmental trajectories post-transplant is crucial for patient care.
Purpose of the Study:
- To assess the long-term growth and developmental outcomes of infants following heart transplantation.
- To compare outcomes between early (0-30 days) and late (31-180 days) transplant recipients.
Main Methods:
- Longitudinal tracking of weight, length, and head circumference for 12 months post-surgery in 110 infants (<6 months).
- Prospective neurodevelopmental evaluation using neurologic examinations and the Bayley Scale of Infant Development in 57 infants.
- Analysis of postoperative seizure incidence in 140 infant recipients.
Main Results:
- Late transplant recipients initially showed poorer growth but achieved comparable growth to early recipients by 6 months post-transplant.
- At 4 months post-transplant, 19% of infants had abnormal neurologic exams, most commonly generalized hypotonia.
- Average Mental Developmental Index was 87 (+/- 21) and Psychomotor Developmental Index was 90 (+/- 21).
- Transient postoperative seizures occurred in 21% of survivors and 33% of nonsurvivors.
Conclusions:
- The majority of infants undergoing heart transplantation before six months of age experience normal growth and development.
- While neurodevelopmental abnormalities and seizures can occur, they do not preclude positive long-term outcomes for most pediatric heart transplant recipients.
Abstract:
The purpose of this study was to examine the long-term growth and developmental outcome of infants undergoing heart transplantation. We studied weight, length, and head circumference from birth to 12 months after surgery in 110 infant recipients less than 6 months of age. Forty-eight early transplant recipients (0 to 30 days) were compared with 62 late transplant recipients (31 to 180 days). Late transplant recipients showed less growth in all parameters at the time of transplant. However, by 6 months after transplantation, there were no differences between the two groups. Growth in 20 infants, now 3 to 7 years old, appears normal. Neurodevelopmental outcome was evaluated prospectively in 57 infants. Four months after transplantation, 11 infants (19%) had abnormal neurologic examinations, with generalized hypotonia (64%) being the most common finding. The Bayley Scale of Infant Development was administered to 48 of 57 infants. The Mental Developmental Index averaged 87 (+/- 21) and the Psychomotor Developmental Index averaged 90 (+/- 21). Of 140 infants who have undergone heart transplantation, transient postoperative seizures occurred in 23 survivors (21%) and 10 nonsurvivors (33%). Our findings suggest that growth, neurologic outcome, and development are normal in the majority of infants who undergo transplantation before 6 months of age.