1. Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life.
- Author
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Ricci MF, Andersen JC, Joffe AR, Watt MJ, Moez EK, Dinu IA, Garcia Guerra G, Ross DB, Rebeyka IM, and Robertson CM
- Subjects
- Brain Damage, Chronic epidemiology, Canada, Cardiopulmonary Bypass, Child, Child, Preschool, Cohort Studies, Disability Evaluation, Disabled Children, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Logistic Models, Male, Prospective Studies, Risk Factors, Time Factors, Brain Damage, Chronic etiology, Cardiac Surgical Procedures adverse effects
- Abstract
Background and Objectives: Little is known about chronic neuromotor disability (CND) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery (CCS). We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors., Methods: This prospective follow-up study included 549 children after CCS requiring cardiopulmonary bypass at ≤6 weeks of age. Groups included those with only 1 CCS, mostly biventricular CHD, and those with >1 CCS, predominantly single ventricle defects. At 4.5 years of age, 420 (94.6%) children received multidisciplinary assessment. Frequency of CND is given as percentage of assessed survivors. Predictors of CND were analyzed using multiple logistic regression analysis., Results: CND occurred in 6% (95% confidence interval [CI] 3.7%-8.2%) of 4.5-year survivors; for 1 CCS, 4.2% (CI 2.3%-6.1%) and >1, 9.8% (CI 7%-12.6%). CND presentation showed: hemiparesis, 72%; spasticity, 80%; ambulation, 72%; intellectual disability, 44%; autism, 16%; epilepsy, 12%; permanent vision and hearing impairment, 12% and 8%, respectively. Overall, 32% of presumed causative events happened before first CCS. Independent odds ratio for CND are age (days) at first CCS, 1.08 (CI 1.04-1.12; P < .001); highest plasma lactate before first CCS (mmol/L), 1.13 (CI 1.03-1.23; P = 0.008); and >1 CCS, 3.57 (CI 1.48-8.9; P = .005)., Conclusions: CND is not uncommon among CCS survivors. The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population. Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND., (Copyright © 2015 by the American Academy of Pediatrics.)
- Published
- 2015
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