Failure to Impact Prevalence of Arterial Ischemic Stroke in Pediatric Cardiac Patients over Three Decades

Hoffman, James P.; Mack, Gordon K.; Minich, L. LuAnn; Benedict, Susan; Heywood, Mason; Stoddard, Gregory J.; Saarel, Elizabeth V.

doi:10.1111/j.1747-0803.2011.00510.x

Cited by 36 publications

(28 citation statements)

References 17 publications

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“…Children with congenital and acquired heart disease are known to be at greater risk for stroke than the general population. Hoffman et al 11 reported an overall incidence of 132 of 100,000 per year, 16-fold higher than the reported incidence in the general pediatric population of between 2 and 8 of 100,000 per year. 12,13 In our population, not surprisingly, a diagnosis of congenital heart disease was a strong independent risk factor for stroke.…”

Section: Discussionmentioning

confidence: 65%

Outcome, incidence and risk factors for stroke after pediatric heart transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry

Morgan

Manlhiot

McCrindle

et al. 2016

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 65%

Outcome, incidence and risk factors for stroke after pediatric heart transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry

Morgan

Manlhiot

McCrindle

et al. 2016

The Journal of Heart and Lung Transplantation

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“…29,33 Specific in utero and perioperative neuroprotective strategies to achieve these goals should be further investigated. 49,50 The strengths of this study include the high proportion of children assessed at 4. …”

Section: Figurementioning

confidence: 99%

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Ricci¹,

Andersen

Joffe

et al. 2015

Pediatrics

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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. WHAT'S KNOWN ON THIS SUBJECT:Neurodevelopmental outcomes after cardiac surgery in early life provide critical information for understanding and improving care. Studies show these children are at risk for arterial ischemic stroke and acquired brain injury; further characterization of motor impairment is needed. WHAT THIS STUDY ADDS:This study focuses on the presence of chronic neuromotor disabilities including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery, providing information on the frequency, characteristics, and predictors that may assist in prevention.

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“…Neonates and children with cardiac disease comprise one of the highest risk populations for pediatric arterial ischemic stroke (AIS), with a reported annual incidence rate ranging from 132 of 100,000 children to one of 100 children 1,2 compared with two to eight of 100,000 in the general pediatric population. 3,4 This risk persists beyond childhood.…”

Section: Introductionmentioning

confidence: 99%

“…5 The prevalence of cardiac disease among children with AIS did not change between 1978 and 2009 despite improvement in acute medical and surgical management and outcomes in children with cardiac disease during this time period. 1 Underlying heart disease contributes to AIS risk through right to left shunting of blood, increased systemic venous pressure, depressed heart function with aberrant flow dynamics, arrhythmias, infective endocarditis, or thrombophilias. 6 In addition, life-saving interventions such as cardiac surgery, cardiac catheterization, and mechanical circulatory support come with the cost of AIS as a potential complication.…”

Section: Introductionmentioning

confidence: 99%

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Chung

Guilliams

Wilson

et al. 2019

Pediatric Neurology

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Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Periprocedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P ¼ 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P ¼ 0.01) compared to those with peri-procedural AIS.

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Failure to Impact Prevalence of Arterial Ischemic Stroke in Pediatric Cardiac Patients over Three Decades

Cited by 36 publications

References 17 publications

Outcome, incidence and risk factors for stroke after pediatric heart transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry

Outcome, incidence and risk factors for stroke after pediatric heart transplantation: An analysis of the International Society for Heart and Lung Transplantation Registry

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

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