Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery
Open accessAbstract
Objective Many studies of neurodevelopmental outcomes after neonatal and infant cardiac surgery have focused on potentially modifiable risk factors for adverse outcomes, primarily intraoperative management strategies and the use of deep hypothermic circulatory arrest. There is increasing evidence that patient-specific factors are more important determinants of outcome.Methods We investigated predictors of neurodevelopmental outcomes at 1 year of age after neonatal and infant cardiac surgery in a subgroup of infants enrolled in a prospective study of apolipoprotein E (APOE) genotype and neurodevelopmental outcome. Children with a variety of 2-ventricle cardiac defects repaired with only 1 operation with cardiopulmonary bypass and no more than 1 episode of deep hypothermic circulatory arrest were included. Neurodevelopmental outcomes at 1 year of age included the Bayley Scales of Infant Development-II, which yield 2 indices, the Mental Developmental Index and the Psychomotor Developmental Index.Results Two hundred forty-seven infants underwent surgical repair between October 1998 and April 2003 with 1 hospital death and 3 deaths before 1 year of age. Neurodevelopmental evaluation was performed in 188 (77%) of 243 survivors, including 56 patients with tetralogy of Fallot, 39 with transposition of the great arteries with intact ventricular septum, 34 with ventricular septal defects, and 59 with other defects. The median age at operation was 56 days (1-186 days), including 72 (38%) neonates. Confirmed or suspected genetic syndromes were present in 59 (31%) of 188 infants. Deep hypothermic circulatory arrest was used in 67 (35%) infants with a median duration of 34 minutes (1-80 minutes). For the entire cohort, the mean Mental Developmental Index was 90.6 +/- 14.9 and the mean Psychomotor Developmental Index was 81.6 +/- 17.2. For patients without genetic syndromes, the mean Mental Developmental Index was 93.7 +/- 13.6 and the mean Psychomotor Developmental Index was 85.1 +/- 14.6. For the entire cohort, predictors of lower scores for both the Mental Developmental Index and Psychomotor Developmental Index were presence of a confirmed or suspected genetic syndrome, lower birth weight, and presence of the APOE epsilon2 allele (all P < .04). Black race was associated with higher scores on the Psychomotor Developmental Index (P = .018). Lower nasopharyngeal temperature during cardiopulmonary bypass was associated with a lower score on the Psychomotor Developmental Index (P = .03) and was the only intraoperative factor that was a significant predictor of either the Mental or Psychomotor Developmental Index.Conclusions The strongest predictors of a worse neurodevelopmental outcome at 1 year of age were patient-specific factors including presence of a genetic syndrome, low birth weight, and presence of the APOE epsilon2 allele. Patient-specific factors eclipsed the use and duration of deep hypothermic circulatory arrest as predictors of worse neurodevelopmental outcomes.
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Maternal education is associated with neurodevelopment in children with CHD.
“Studies have demonstrated the association of maternal education with neurodevelopment in children with CHD [7, 27].”
From Early Evaluation and the Effect of Socioeconomic Factors on Neurodevelopment in Infants with Tetralogy of Fallot. (2021) · cites this paper as [27]
The Discussion reports associations between social class and neurodevelopmental outcomes in other CHD studies, but does not identify maternal education as the measure. In the One-year Neurodevelopmental Evaluation, socioeconomic status was not a significant predictor of the developmental scores in this cohort. Searches for maternal education and parental educational attainment found no passage establishing the specific association claimed; page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMaternal education, socioeconomic status and genetic abnormalities are known clinical factors that affect neurodevelopmental outcomes in CHD through pathways unrelated to brain injury.
“In contrast, several important clinical variables are known to influence ND outcomes in children with CHD through mechanisms that don’t involve brain injury, including maternal education, socioeconomic status and presence of a genetic abnormality (14–16).”
From Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease (2018) · cites this paper as [16]
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Neurodevelopmental outcome in children with congenital heart disease
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Gross motor development is delayed following early cardiac surgery
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Cause and Prevention of Central Nervous System Injury in Neonates Undergoing Cardiac Surgery
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Self-citationBehavior and Quality of Life at 6 Years for Children With Hypoplastic Left Heart Syndrome
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A Predictive Model for Neurodevelopmental Outcome After the Norwood Procedure
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Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease
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Self-citationEarly Neurodevelopmental Outcomes in Children Supported with ECMO for Cardiac Indications
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“Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect (CHD), with a yearly incidence of one per 2500 live births in the United States [1].”
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Self-citation
- Authors
- Gaynor, J. W., Wernovsky, G., Jarvik, G. P., Bernbaum, J., Gerdes, M., Zackai, E., Nord, A. S., Clancy, R. R., Nicolson, S. C., & Spray, T. L.
- Affiliations
- Children's Hospital of Philadelphia (US)
- University of Washington (US)
- Corresponding author
- Gaynor, J. William
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2007-05
- Volume
- 133
- Issue
- 5
- Pages
- 1344-1353.e3
- ISSN
- 0022-5223 (ISSN-L)
- PMC
- PMC2844117
- OpenAlex
- W2066383852
- Cited by
- 270
- References
- 22
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 8 · 2023: 15 · 2022: 12 · 2021: 14 · 2020: 13 · 2019: 11 · 2018: 12 · 2017: 18 · 2016: 17 · 2015: 10 · 2014: 11 · 2013: 16 · 2012: 13
- FWCI
- 11.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association (HL071834, 9950480N)
- National Institutes of Health (9950480N, HL071834)
- National Heart, Lung, and Blood Institute (HL-071834, R01HL071834)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- neurodevelopmental outcomes, neonatal cardiac surgery, infant cardiac surgery, congenital heart disease, genetic syndromes, APOE genotype, deep hypothermic circulatory arrest, cardiopulmonary bypass, birth weight, tetralogy of Fallot, transposition of the great arteries, ventricular septal defect, Bayley Scales of Infant Development II, cognitive development
- MeSH terms
- Birth Weight, Cardiopulmonary Bypass, Child Development, Developmental Disabilities, Female, Genotype, Heart Arrest, Induced, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Hypothermia, Induced, Infant, Infant, Newborn, Male, Neuropsychological Tests, Polymorphism, Genetic, Risk Factors, Apolipoprotein E2
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