Neuropsychomotor development before and after open-heart surgery in infants

Abstract

-There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67±23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.Key WorDs: cardiac surgery, developmental delay, Denver II test.desenvolvimento neuropsicomotor de lactentes antes e após cirurgia cardíaca resumo -As alterações neurológicas em lactentes com cardiopatia congênita podem agravar seu quadro clínico e levar a seqüelas permanentes. Foi realizada uma coorte prospectiva, com 20 lactentes, com idade média de 6,7±4,2 meses, avaliando-se o perfil de desenvolvimento e o estado nutricional. Utilizou-se o exame neurológico e o teste de Denver II. os testes foram aplicados 24h antes da cirurgia, na alta da unidade de terapia intensiva e 3 a 6 meses após. os defeitos septais ocorreram em 11 casos (55%). o tempo médio de circulação extra-corpórea foi de 67±23,6 minutos. Quinze crianças tinham exame neurológico alterado e atraso no desenvolvimento neuropsicomotor antes da cirurgia, cuja normalização foi observada somente em seis após 6 meses .Quanto aos índices de Denver II, houve aumento em todos domínios, exceto o pessoalsocial. o escore Z médio para peso antes da cirurgia foi -2,814±1,98 e após -1,08±1,47 (p<0.05), o qual foi realizado em média 5.2±1.5 meses após a alta hospitalar. Melhora precoce tanto no desenvolvimento como no estado nutricional pôde ser observada neste grupo de lactentes após a correção cirúrgica.PAlAvrAs-cHAve: cirurgia cardíaca, atraso no desenvolvimento neurológico, teste de Denver II, cardiopatia congênita. corrective cardiac surgery involves a series of complex and high risk procedures and a large number of them expose the brain to hypoxic ischemic insults 1 . Prospective studies have shown that 100% of children who undergo cardiac surgery present with central nervous system dysfunctions in the immediate post-operative period 2 as a consequence of alterations in the cerebral blood flow. If the hypoxic ischemic insult is acute and extensive, the patients may not regain consciousness in the immediate post-operative period and stand increased chances of irreversible sequelae. some of the neurological findings that may be observed are seizures, alterations of consciousness, behavioral disorders, intellectual impairment, focal deficit, involuntary movements, and lesions to the periph-

Brain abnormalities and neurodevelopmental delay in congenital heart disease: systematic review and meta-analysis

“…Preoperative features of neurodevelopmental delay described in neonates and infants with CHD include seizures, hypotonia, hypertonia, motor asymmetry, inability to suck, feeding difficulties, cranial nerve abnormalities, lethargy, restlessness, agitation and autistic features. These abnormalities are more common in cyanotic infants with oxygen saturation of < 85%.…”

Congenital Heart Disease and Impacts on Child Development

“…Of the 20 infants evaluated, 15 had altered neurological examination and developmental delay before surgery, whose normalization was observed only six months after the procedure in six participants. The authors concluded that after five months on average, the frequency of surgery was reduced among children with Denver II "suspect" delay from 75% to 55% [ 19 ] .…”

Motor Impairment in Children With Congenital Heart Defects: A Systematic Review

“…Studies included in this review originated from 5 continents. Sixteen (35%) studies were conducted in the United States, 15-30 7 (15%) in Canada, 31-37 6 (13%) in Germany, 38-43 4 (9%) in Australia, [44][45][46][47] 2 (4%) in the Netherlands, 48,49 2 (4%) in Switzerland, 50,51 2 (4%) in Finland, 52,53 2 (4%) in Japan, 54,55 1 (2%) in Brazil, 56 1 (2%) in India, 57 and 1 (2%) in Norway. 58 In addition, 2 (4%) studies were conducted in centers located both in Canada and the United States.…”

“…In this study, the authors reported a 20.0% prevalence of motor skill difficulties. 21 Additionally, da Rocha et al 56 reported suspected delays in 55.0% of infants with CHD on the basis of the results of a screening test. The prevalence of severe motor impairments (,22 SD) in infants with CHD ranged from 0.0% to 54.6% (IQR: 8.4%-50.9%).…”