Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy
Abstract
Objective: Historical cohort studies have reported adverse neurodevelopment following cardiac surgery during early infancy. Advances in surgical techniques and perioperative care have coincided with updating of neurodevelopmental assessment tools. We aimed to determine perioperative risk factors for impaired neurodevelopment at 2 years following surgery for congenital heart disease (CHD) in early infancy. Design and patients: We undertook a prospective longitudinal study of 153 full-term infants undergoing surgery for CHD before 2 months of age. Infants were excluded if they had a genetic syndrome associated with neurodevelopmental impairment. Outcome measures: Predefined perioperative parameters were recorded and infants were classified according to cardiac anatomy. At 2 years, survivors were assessed using the Bayley Scales of Infant Development-III. Results: At 2 years, 130 children (98% of survivors) were assessed. Mean cognitive, language and motor scores were 93.4±13.6, 93.6±16.1 and 96.8±12.5 respectively (100±15 norm). Twenty (13%) died and 12 (9%) survivors had severe impairment (score <70), mostly language (8%). The lowest scores were in infants born with single ventricle physiology with obstruction to the pulmonary circulation who required a neonatal systemic-to-pulmonary artery shunt. Additional risk factors for impairment included reduced gestational age, postoperative elevation of lactate or S100B and repeat cardiac surgery. Conclusions: In the modern era of infant cardiac surgery and perioperative care, children continue to demonstrate neurodevelopmental delays. The use of updated assessment tools has revealed early language dysfunction and relative sparing of motor function. Ongoing follow-up is critical in this high-risk population.
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Most studies find worse short- and long-term outcomes in patients with congenital heart disease than in healthy controls, and delays are more severe in single ventricle pathology than in biventricular defects.
“Most studies report adverse short-and long-term outcomes in patients with CHD when compared with healthy controls, with more severe delays in single ventricle pathology (SVP) compared with biventricular cardiac defects.6”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [6]
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- Authors
- Gunn, J. K., Beca, J., Hunt, R. W., Goldsworthy, M., Brizard, C. P., Finucane, K., Donath, S., & Shekerdemian, L. S.
- Affiliations
- Royal Children's Hospital (AU)
- Starship Children's Health (NZ)
- Texas Children's Hospital (US)
- The University of Melbourne (AU)
- Baylor College of Medicine (US)
- Corresponding author
- Shekerdemian, Lara S
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2016-06-06
- Volume
- 101
- Issue
- 11
- Pages
- 1010-1016
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W2414449444
- Cited by
- 92
- References
- 40
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 6 · 2023: 11 · 2022: 17 · 2021: 8 · 2020: 15 · 2019: 7 · 2018: 4 · 2017: 6 · 2016: 2
- FWCI
- 5.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Heart Foundation of New Zealand
- State Government of Victoria
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- congenital heart disease, infant cardiac surgery, neurodevelopmental impairment, perioperative risk factors, language delay, single ventricle, systemic-to-pulmonary shunt, gestational age, lactate, S100B, repeat cardiac surgery, Bayley Scales of Infant Development III, early infancy
- MeSH terms
- Developmental Disabilities, Child, Preschool, Cognition Disorders, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Intraoperative Care, Longitudinal Studies, Male, Postoperative Complications, Prospective Studies, Psychomotor Disorders, Risk Factors
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