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Neurodevelopmental outcomes after cardiac surgery in infancy
- Source :
- Pediatrics, vol 135, iss 5
- Publication Year :
- 2015
-
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.
- Subjects :
- Heart Defects, Congenital
Male
medicine.medical_specialty
Pediatrics
Time Factors
Heart disease
Birth weight
Developmental Disabilities
Clinical Trials and Supportive Activities
Population
Cardiovascular
Medical and Health Sciences
Bayley Scales of Infant Development
Nervous System
neurodevelopmental outcomes
Hypoplastic left heart syndrome
Congenital
Postoperative Complications
Clinical Research
Risk Factors
Medicine
Humans
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators
Cardiac Surgical Procedures
education
Heart Defects
Pediatric
Psychomotor learning
education.field_of_study
business.industry
Psychology and Cognitive Sciences
Infant
Perinatal Period - Conditions Originating in Perinatal Period
medicine.disease
congenital heart defects
Confidence interval
Cardiac surgery
Quality Education
Heart Disease
Pediatrics, Perinatology and Child Health
Multivariate Analysis
Congenital Structural Anomalies
Female
cardiopulmonary bypass
business
cardiac surgery
Subjects
Details
- ISSN :
- 10984275
- Volume :
- 135
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Pediatrics
- Accession number :
- edsair.doi.dedup.....59f43fcfa77960fa71b23ab41d3d95bf