A Systematic Review of Motor and Cognitive Outcomes After Early Surgery for Congenital Heart Disease

Snookes, Suzanne H; Gunn, Julia; Eldridge, Bev; Donath, Susan; Hunt, Rod W.; Galea, Mary P.; Shekerdemian, Lara

doi:10.1542/peds.2009-1959

Cited by 219 publications

(185 citation statements)

References 93 publications

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“…Children with congenital heart disease (CHD) are at risk for developmental delays (DDs). [1][2][3][4] A characteristic pattern of a high prevalence of low-severity or combined disabilities in the areas of visual motor integration, language, motor skills, attention, executive function, and behavior has been described in multiple research studies. [5][6][7] Although many studies have reported outcomes near 1 year of age, no previous studies have obtained serial measures by using a consistent developmental assessment tool in young children throughout the first 3 years of life.…”

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confidence: 99%

Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children with congenital heart disease demonstrate a high prevalence of low-severity developmental problems in the areas of language, motor skills, attention, and executive function. Systematic evaluation has been recommended to promote early detection of problems and ensure appropriate intervention. WHAT THIS STUDY ADDS:This study presents results of longitudinal testing in early childhood. Developmental delays were common. Feeding difficulty and medical and genetic comorbidities increased risk for delays. Exposure to risk and prevalence of delay change over time; therefore, repeated evaluations are warranted.abstract BACKGROUND AND OBJECTIVE: Children with congenital heart disease (CHD) are at risk for developmental delay (DD). Changes in cognitive, language, and motor skills in early childhood have not been described. We report the results of a structured approach using longitudinal testing to identify problems and ensure early intervention in accordance with published guidelines.METHODS: Bayley Scales of Infant Development, Third Edition, were used to assess cognitive, language, and motor skills in 99 children with CHD. Subjects were evaluated 3 to 6 times in the first 3 years of life. DD was defined as scores .1 SD below the population mean. RESULTS:Cardiac anatomy was single ventricle (1V) in 34 subjects and 2 ventricles (2V) in 65. Medical comorbidities were present in 21% and genetic syndromes in 19%. Most subjects (75%) had DD in $1 area at $1 assessments. Subjects with 1V anatomy had equivalent outcomes to those with 2V. Cognitive and language scores declined in subjects with genetic syndromes but were stable and within the average range for subjects with 1V and 2V. Motor scores improved for subjects with 1V and 2V but remained low for those with genetic syndromes. In addition to age, need for supplemental tube feeding, longer cardiopulmonary bypass time, and shorter time since last hospitalization were significant predictors of developmental outcomes.CONCLUSIONS: DDs in young children with CHD are both common and dynamic. Providers should encourage longitudinal surveillance for children with CHD because exposure to risk and prevalence of DD change over time. Pediatrics 2014;133:e570-e577 AUTHORS:

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Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

et al. 2014

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“…The impact of this impairment is far-reaching and may not be manifest very early in life but instead may become apparent in later childhood, often extending into adolescence. [1][2][3][4][5] Given the potential relationship between brain injury and impaired outcome, and the possibility that aspects of cardiac surgery could further worsen preexisting brain injury, preoperative brain imaging is commonly used in the clinical setting as well as in the context of prospective investigations of brain injury in this highrisk group.The spectrum of brain injury affecting newborns with heart disease includes stroke or infarct, hemorrhage, and white matter injury (WMI), as well as more subtle maturational, structural, and metabolic abnormalities. Although the impact of these changes on subsequent neurodevelopment is not yet clear, there is an increasing appreciation for the importance of preoperative evaluation in this population.…”

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confidence: 99%

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Routine head ultrasound scans (HUSs) are frequently performed in the preoperative evaluation of the infants with congenital heart disease, and brain MRI is being increasingly used in the research setting. The utility of HUSs in this population has not yet been established. WHAT THIS STUDY ADDS:This is the first study to prospectively evaluate the utility of routine HUSs compared with MRIs in asymptomatic newborns and young infants undergoing cardiac surgery. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD.abstract OBJECTIVE: The purpose of this study was to assess the utility of preoperative head ultrasound scan (HUS) in a cohort of newborns also undergoing preoperative MRI as part of a prospective research study of brain injury in infants having surgery for congenital heart disease (CHD). METHODS: A total of 167 infants diagnosed with CHD were included in this 3-center study. None of the patients had clinical signs or symptoms of preoperative brain injury, and all patients received both HUS and brain MRI before undergoing surgical intervention. HUS and MRI results were reported by experienced neuroradiologists who were blinded to any specific clinical details of the study participants. The findings of the individual imaging modes were compared to evaluate for the presence of brain injury. RESULTS: Preoperative brain injury was present on HUS in 5 infants (3%) and on MRI in 44 infants (26%) (P , .001). Four of the HUS showed intraventricular hemorrhage not seen on MRI, suggesting false-positive results, and the fifth showed periventricular leukomalacia. The predominant MRI abnormality was white matter injury (n = 32). Other findings included infarct (n = 16) and hemorrhage (n = 5). CONCLUSIONS: Preoperative brain injury on MRI was present in 26% of infants with CHD, but only 3% had any evidence of brain injury on HUS. Among positive HUS, 80% were false-positive results. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD, and MRI may be a preferable tool when the assessment of these infants is warranted. Pediatrics 2013;131:e1765-e1770 Neurodevelopmental impairment is the most common long-term, noncardiac morbidityaffecting neonates undergoing surgery for congenital heart disease (CHD). The impact of this impairment is far-reaching and may not be manifest very early in life but instead may become apparent in later childhood, often extending into adolescence. [1][2][3][4][5] Given the potential relationship between brain injury and impaired outcome, and the possibility that aspects of cardiac surgery could further worsen preexisting brain injury, preoperative brain imaging is commonly used in the clinical setting as well as in the context of prospective investigations of brain injury in this highrisk group.The spectrum of brain injury affecting newborns with heart disease includes stroke or infarct, hemorrhage, and white matter injury (...

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“…There is clear data to show that infants with CCHD who present collapsed will have a worse neurological outcome than those who are identified before a collapse [3]. As a significant number of infants with CCHD present in the first 24 h with early ductal closure [25], planning a screening program in the first 24 h will result in less collapsed presentations and provide an opportunity for earlier stabilization and intervention.…”

Section: Timing Of Pulse Oximetry Screening and Significance Of Falsementioning

confidence: 99%

“…Neurological outcome is related to the presentation of the disease, with infants who collapse prior to presentation having a significantly worse outcome than those that are identified prior to collapse [3]. There is therefore a need for the development of effective screening tests for CCHD.…”

Section: Introductionmentioning

confidence: 99%

Barriers to the Implementation of Newborn Pulse Oximetry Screening: A Different Perspective

Kluckow

2018

IJNS

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Pulse oximetry screening of the well newborn to assist in the diagnosis of critical congenital heart disease (CCHD) is increasingly being adopted. There are advantages to diagnosing CCHD prior to collapse, particularly if this occurs outside of the hospital setting. The current recommended approach links pulse oximetry screening with the assessment for CCHD. An alternative approach is to document the oxygen saturation as part of a routine set of vital signs in each newborn infant prior to discharge, delinking the measurement of oxygen saturation from assessment for CCHD. This approach, the way that many hospitals which contribute to the Australian New Zealand Neonatal Network (ANZNN) have introduced screening, has the potential benefits of decreasing parental anxiety and expectation, not requiring specific consent, changing the interpretation of false positives and therefore the timing of the test, and removing the pressure to perform an immediate echocardiogram if the test is positive. There are advantages of introducing a formal screening program, including the attainment of adequate funding and a universal approach, but the barriers noted above need to be dealt with and the process of acceptance by a national body as a screening test can take many years.

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A Systematic Review of Motor and Cognitive Outcomes After Early Surgery for Congenital Heart Disease

Cited by 219 publications

References 93 publications

Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

Barriers to the Implementation of Newborn Pulse Oximetry Screening: A Different Perspective

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