Background
Expectations for outcomes after the neonatal arterial switch operation (ASO) continue to change. This cohort study describes neurodevelopmental outcomes at age 12 months after neonatal ASO, and analyzes both modifiable, and non-modifiable factors for association with adverse outcomes.
Methods
ASO patients (n=30) were enrolled in a prospective outcome study, with comprehensive clinical data collection over the first 12 months of life. Brain magnetic resonance imaging (MRI) was done preoperatively and 7 days postoperatively, Bayley Scales of Infant Development III was performed at age 12 months.
Results
Ten of 30 patients (33%) had preoperative MRI injury; 13 of 30 (43%) had new postoperative MRI injury. 20 (67%) patients had Bayley Scales of Infant Development III: Cognitive score mean was 104.8 ± 15.0, Language score median was 90.0 (25th–75th percentile 83–94), and Motor score mean was 92.3 ± 14.2. Best subsets multivariable analysis found associations between lower preoperative and intraoperative cerebral oxygen saturation, preoperative MRI brain injury, total bypass time, and total midazolam dose and lower Bayley Scales of Infant Development III scores at age 12 months.
Conclusions
At 12 months after ASO, neurodevelopmental outcome means were within normal population ranges. The new associations reported in this study between potentially modifiable perioperative factors and outcomes require investigations in larger patient cohorts. Beyond survival, which was 100% in this cohort, factors influencing quality of life including neurodevelopmental outcomes, should be routinely investigated in studies of ASO patients.