Cited by 518Congenital Heart Disease StudiesCardiovascular Conditions and TreatmentsCardiac and Coronary Surgery Techniques

Neurodevelopmental Outcomes After Cardiac Surgery in Infancy

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Gaynor, J. William, Stopp, Christian, Wypij, David, Andropoulos, Dean B., Atallah, Joseph, Atz, Andrew M., Beca, John, Donofrio, Mary T. +21 more·2015·Pediatrics

Abstract

BACKGROUND: Neurodevelopmental disability is the most common complication for survivors of surgery for congenital heart disease (CHD). METHODS: We analyzed individual participant data from studies of children evaluated with the Bayley Scales of Infant Development, second edition, after cardiac surgery between 1996 and 2009. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI). RESULTS: Among 1770 subjects from 22 institutions, assessed at age 14.5 ± 3.7 months, PDIs and MDIs (77.6 ± 18.8 and 88.2 ± 16.7, respectively) were lower than normative means (each P < .001). Later calendar year of birth was associated with an increased proportion of high-risk infants (complexity of CHD and prevalence of genetic/extracardiac anomalies). After adjustment for center and type of CHD, later year of birth was not significantly associated with better PDI or MDI. Risk factors for lower PDI were lower birth weight, white race, and presence of a genetic/extracardiac anomaly (all P ≤ .01). After adjustment for these factors, PDIs improved over time (0.39 points/year, 95% confidence interval 0.01 to 0.78; P = .045). Risk factors for lower MDI were lower birth weight, male gender, less maternal education, and presence of a genetic/extracardiac anomaly (all P < .001). After adjustment for these factors, MDIs improved over time (0.38 points/year, 95% confidence interval 0.05 to 0.71; P = .02). CONCLUSIONS: Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved modestly over time, but only after adjustment for innate patient risk factors. As more high-risk CHD infants undergo cardiac surgery and survive, a growing population will require significant societal resources.

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  • Greater birth weight is associated with better neurodevelopment scores in patients with TOF.

    “Similarly to the study by Gaynor et al., we found that greater birth weight was associated with better neurodevelopment scores [6].”

    From Early Evaluation and the Effect of Socioeconomic Factors on Neurodevelopment in Infants with Tetralogy of Fallot. (2021) · cites this paper as [6]

    Table 3 (Multivariable regression analyses; page unavailable) shows that greater birth weight was significantly associated with a higher Mental Development Index score in the TOF subgroup (P = .006). The association with the Psychomotor Development Index was positive but not statistically significant (P = .13), so the claim overstates the evidence if “scores” refers to both measures. (LLM, conf=0.88)

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  • Neurodevelopmental outcomes in children with critical CHD have improved only modestly despite better survival and perioperative care.

    “Despite significant improvements over time in survival, surgical strategies and perioperative care, neurodevelopmental (ND) outcomes have only modestly improved (6).”
  • Psychomotor and cognitive development scores are below normative means in one- and two-year-olds who had cardiac surgery as neonates.

    “Psychomotor and cognitive development indices are lower than normative means in 1-and 2-year-olds who underwent neonatal cardiac surgery.[7][8][9][10]”

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Authors
Gaynor, J. W., Stopp, C., Wypij, D., Andropoulos, D. B., Atallah, J., Atz, A. M., Beca, J., Donofrio, M. T., Duncan, K., Ghanayem, N. S., Goldberg, C. S., Hövels-Gürich, H., Ichida, F., Jacobs, J. P., Justo, R., Latal, B., Li, J. S., Mahle, W. T., McQuillen, P. S., Menon, S. C., Pemberton, V. L., Pike, N. A., Pizarro, C., Shekerdemian, L. S., Synnes, A., Williams, I., Bellinger, D. C., Newburger, J. W., & for the International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators
Affiliations
  • Children's Hospital of Philadelphia (US)
  • Boston Children's Hospital (US)
  • Baylor College of Medicine (US)
  • Stollery Children's Hospital (CA)
  • Medical University of South Carolina (US)
  • Greenlane Clinical Centre (NZ)
  • Children's National (US)
  • Children's Hospital & Medical Center (US)
  • Children's Hospital of Wisconsin (US)
  • C. S. Mott Children's Hospital (US)
  • Universitätsklinikum Aachen (DE)
  • Toyama University Hospital (JP)
  • Johns Hopkins University (US)
  • The University of Queensland (AU)
  • University Children's Hospital Zurich (CH)
  • Duke Medical Center (US)
  • Children's Healthcare of Atlanta (US)
  • University of California, San Francisco (US)
  • Primary Children's Hospital (US)
  • National Heart, Lung, and Blood Institute (US)
  • Children's Hospital Los Angeles (US)
  • Alfred I. duPont Hospital for Children (US)
  • Royal Children's Hospital (AU)
  • University of British Columbia (CA)
  • New York-Presbyterian Morgan Stanley Children’s Hospital of New York, New York, New York
Venue
Pediatrics
Published
2015-05-01
Volume
135
Issue
5
Pages
816-825
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
OpenAlex
W2134760496
Cited by
518
References
39
Citations by year
2026: 36 · 2025: 40 · 2024: 34 · 2023: 60 · 2022: 67 · 2021: 52 · 2020: 58 · 2019: 49 · 2018: 43 · 2017: 38 · 2016: 33 · 2015: 7 · 2014: 1
FWCI
31.62
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Lincoln (University of Nebraska) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • RWTH Publications (RWTH Aachen) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Funders
  • March of Dimes Foundation (0365018Y, 6-FY2009-303)
  • American Heart Association (2002/3E, 9950480N, 0365018Y)
  • Larry L. Hillblom Foundation (2002/3E)
  • Intensive Care Society
  • National Heart Foundation of Australia
  • Stiftung Mercator Schweiz
  • Stiftung Mercator
  • National Institutes of Health (5r01hl041786-13, 2u01hl068281-06)
  • Canadian Institutes of Health Research (MOP93780)
  • National Heart, Lung, and Blood Institute (HL085057, HL 41786, U01HL068288, HL068281, U10HL109741, U01-HL-068281, U01HL068292, U10HL068270, U01HL068290, HL068269, HL068270, HL068279, HL068281, HL068285, HL068288, HL068290, HL068292, HL085057, HL068270, U01HL068285, HL068290, U01HL085057, HL068269, HL068285, U01HL068270, HL068288, U01HL068279, U01HL068269, HL068279, HL 063411, HL068292, U01HL063411)
  • National Institute of Neurological Disorders and Stroke (R01NS063876, NS40117, NS-35902, NS063876, R01NS040117, P50NS035902)
  • National Center for Research Resources (RR-01271, M01RR001271, UL1RR025758, M01RR002172, RR02172)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD055501, HD18655, HD055501, P30HD018655)
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, congenital heart disease, psychomotor development, cognitive development, Bayley Scales of Infant Development, birth weight, temporal trends in outcomes, risk factors, maternal education, sex differences
MeSH terms
Developmental Disabilities, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Male, Nervous System, Postoperative Complications, Risk Factors, Time Factors, Multivariate Analysis

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