Neuro developmental outcomes after cardiac surgery in infancy

Gaynor, J. William, Stopp, Christian, Wypij, David, Andropoulos, Dean B., Atallah, Joseph, Atz, Andrew M., Beca, John, Donofrio, Mary T., Duncan, Kim, Ghanayem, Nancy S., Goldberg, Caren S., Hovels-Gurich, Hedwig, Ichida, Fukiko, Jacobs, Jeffrey P., Justo, Robert, Latal, Beatrice, Li, Jennifer S., Mahle, William T., McQuillen, Patrick S., Menon, Shaji C., Pemberton, Victoria L., Pike, Nancy A., Pizarro, Christian, Shekerdemian, Lara S., Synnes, Anne, Williams, Ismee, Bellinger, David C. and Newburger, Jane W. (2015) Neuro developmental outcomes after cardiac surgery in infancy. Pediatrics, 135 5: 816-825. doi:10.1542/peds.2014-3825

Author Gaynor, J. William
Stopp, Christian
Wypij, David
Andropoulos, Dean B.
Atallah, Joseph
Atz, Andrew M.
Beca, John
Donofrio, Mary T.
Duncan, Kim
Ghanayem, Nancy S.
Goldberg, Caren S.
Hovels-Gurich, Hedwig
Ichida, Fukiko
Jacobs, Jeffrey P.
Justo, Robert
Latal, Beatrice
Li, Jennifer S.
Mahle, William T.
McQuillen, Patrick S.
Menon, Shaji C.
Pemberton, Victoria L.
Pike, Nancy A.
Pizarro, Christian
Shekerdemian, Lara S.
Synnes, Anne
Williams, Ismee
Bellinger, David C.
Newburger, Jane W.
Title Neuro developmental outcomes after cardiac surgery in infancy
Journal name Pediatrics   Check publisher's open access policy
ISSN 1098-4275
Publication date 2015-05-01
Sub-type Article (original research)
DOI 10.1542/peds.2014-3825
Open Access Status Not yet assessed
Volume 135
Issue 5
Start page 816
End page 825
Total pages 10
Place of publication Elk Grove Village, IL, United States
Publisher American Academy of Pediatrics
Language eng
Formatted 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.
Keyword Infant
Cardiac surgery
Neurodevelopmental outcomes
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2016 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 54 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 48 times in Scopus Article | Citations
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