Neurodevelopment at 1 year of age in infants with congenital heart disease

Abstract

Objective: To assess psychomotor development and neurological sequelae in infants after surgery for congenital heart defects. Design and setting: Single institution prospective cohort study. Patients: 90 of 112 consecutive surviving infants of less than 1 year of age, without brain anomalies, conditions, or syndromes associated with delayed mental development, who underwent cardiac surgery during an 18 month period; 20 control infants with minor or no congenital heart defects. Main outcome measures: Griffiths developmental scales and standardised neurological examination at 1 year. Results: Mean (SD) developmental quotient (DQ) in index infants was 99 (10.6), compared with 106.7 (6.6) in controls (p < 0.001). DQ was lower in infants after palliative surgery (n = 16; 88 (12.2)) than after corrective surgery (n = 74; 101.4 (8.6)) (p < 0.001). Of the 90 index infants, 24 (27%) had a DQ below 93.5 (more than 2 SD below the mean of controls). Developmental delay (DQ < 93.5) was more common after palliative surgery (10/16, 63%) than after corrective surgery (14/74, 19%) (p < 0.001). Of the 90 index infants, 29 (32%) had neurological abnormalities, compared with only one of the 20 controls (5%) (p = 0.013). Neurological abnormalities were more frequent after palliative surgery (11/16, 69%) than after corrective surgery (18/74, 24%) (p < 0.001).Conclusions: There is a considerable rate of neurodevelopmental impairment at 1 year of age in infants after cardiac surgery. Psychomotor impairment and neurological sequelae are apparently more severe in infants in whom only palliative surgery is possible.

Outcome analysis of major cardiac operations in low weight neonates

“…Moreover, although this particular patient population is at risk for developmental impairment by the low weight itself, the cardiac disorder, the often associated syndromes, and the early surgery including the eventual use of extracorporeal perfusion, the clinical neuropsychological evolution in this series seems acceptable with only one procedure related event. However, the application of more refined neurodevelopmental scales could, perhaps, objectivate more appropriately psychomotor sequellae as has been reported by Dittrich and colleagues [13] in a prospective assessment of one-year-old children after surgery for congenital heart disorders.…”

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

“…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.…”

Detección precoz de trastornos del neurodesarrollo en los primeros años de vida en niños con cardiopatías congénitas

“…Dittrich et al (2003) defendían que cuando se realizaba una intervención quirúrgica en el período neonatal se producían secuelas en el habla y en el lenguaje.…”

“…El estudio realizado por Dittrich et al (2003) nos muestra que existen diferencias en el desarrollo motor entre los infantes debido a las malformaciones cardiacas de aquellos que no las presentan. Estas diferencias se evidencian en las destrezas motoras, en las habilidades personales y sociales, en el rendimiento cognitivo y en el lenguaje.…”