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Published on: January 11, 2016
Cognitive and motor development in preschool and school-aged children after neonatal arterial switch operation
H H Hövels-Gürich1, M C Seghaye, S Däbritz
1Department of Pediatric Cardiology, RWTH Aachen, Germany.
Insights
Children who underwent neonatal arterial switch operations show higher rates of neurologic and motor impairments. Cognitive functions remain well-tolerated, but motor skills and vocabulary may be affected long-term.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Pediatric Neurology
Background:
- The long-term developmental outcomes for children undergoing neonatal arterial switch operations (ASO) are not well-established.
- Neonatal ASO is a critical procedure for complex congenital heart defects.
Purpose of the Study:
- To systematically evaluate the developmental status of children beyond three years of age following neonatal arterial switch operation.
- To assess neurodevelopmental outcomes, including cognitive function, motor skills, and acquired abilities.
Main Methods:
- Seventy-seven children who had neonatal ASO were examined between 3.2 and 9.4 years of age.
- Evaluations included clinical neurologic status, intelligence testing, acquired abilities, vocabulary, and gross and fine motor function assessments.
- Results were correlated with preoperative, perioperative, and postoperative factors.
Main Results:
- Neurologic impairment occurred in 9.1% of children, exceeding the general population rate.
- While overall intelligence was comparable to controls, motor function (fine and gross) and vocabulary were poorer.
- Reduced intelligence was observed in 9.1%, fine motor dysfunction in 22.1%, and gross motor dysfunction in 23.4%.
Conclusions:
- Neonatal arterial switch operation using deep hypothermic circulatory arrest and low-flow bypass is associated with neurologic and motor impairments.
- Cognitive functions, as assessed by formal intelligence testing, appear well-tolerated in these patients.
- Long-term monitoring for motor and neurodevelopmental deficits is warranted.
Objective:
The developmental status of children beyond 3 years of age after the neonatal arterial switch operation has not yet been systematically evaluated and is the topic of the present work.
Methods:
Seventy-seven unselected children operated on as neonates with combined deep hypothermic circulatory arrest and low-flow cardiopulmonary bypass were examined at an age of 3.2 to 9.4 years (5.4 +/- 1.6 years, mean +/- standard deviation). Clinical neurologic status, standard scores of intelligence, acquired abilities and vocabulary, and standardized tests on gross motor and fine motor functions were carried out, and the results were related to preoperative, perioperative, and postoperative status and management.
Results:
Neurologic impairment was more frequent (9.1%) than in the normal population. Intelligence was not different in these patients compared with normal children (p = 0.11), but motor function, vocabulary, and acquired abilities were poorer. Reduced intelligence was found in 9.1%, fine motor dysfunction in 22.1%, and gross motor dysfunction in 23.4% of the children. Intelligence was weakly but significantly inversely related to the duration of bypass (Spearman correlation coefficient -0.25, p = 0.03) and tended to be inversely related to the duration of circulatory arrest (-0.21, p = 0.07), but not to core cooling time on bypass or degree of hypothermia. Gross motor function, vocabulary, and acquired abilities were not significantly related to any of the perioperative parameters considered. No correlation was found between the test results and the variables perinatal asphyxia, perioperative and postoperative cardiocirculatory insufficiency, resuscitation events, and plexal or intraventricular cerebral hemorrhage.
Conclusions:
The neonatal arterial switch operation with combined circulatory arrest and low-flow bypass in our experience is associated with neurologic as well as fine and gross motor impairment but appears to be well tolerated concerning cognitive functions as based on formal intelligence testing.
