Background Children undergoing complex cardiac surgery are exposed to substantial cumulative doses of sedative medications and volatile anesthetics and are more frequently anesthetized with ketamine, compared with healthy children. We hypothesized that greater exposure to sedation and anesthesia in this population is associated with lower neurodevelopmental scores at 18-months of age. Methods We conducted a secondary analysis of infants with congenital heart disease who participated in a prospective observational study of environmental exposures and neurodevelopmental outcomes to assess the impact of cumulative volatile anesthetic agents and sedative medications. Cumulative minimum alveolar concentration hours of exposure to volatile anesthetic agents and all operating room and intensive care unit exposures to sedative and anesthesia medications were collected prior to administration of Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 18-months of age. Results The study cohort included 41 (37%) single-ventricle and 69 (63%) two-ventricle patients. Exposures to volatile anesthetic agents, opioids, benzodiazepines and dexmedetomidine were not associated with abnormal Bayley-III scores. At 18-month follow-up, after adjusting for confounders, each mg/kg increase in ketamine exposure was associated with a 0.34 (95%CI: -0.64, -0.05) point decrease in Bayley-III Motor scores, P = 0.024. Conclusions Total cumulative exposures to volatile anesthetic agents were not associated with neurodevelopmental impairment in infants with congenital heart disease undergoing various imaging studies and procedures, whereas higher ketamine doses were associated with poorer motor performance.

Introduction: Resilience is the ability to recover after stressful events and is believed to help reduce the long-term adverse effects. The role of resilience as a determinant of neurodevelopmental (ND) outcomes and quality of life (QOL) in young adults with congenital heart disease (CHD) has not been fully delineated. Hypothesis: Higher resilience in young adults with CHD is associated with better QOL and can be predicted by patient factors and ND status in the preschool period. Methods: Prospective evaluation of subjects ≥ 18 years of age enrolled in a study of genetic determinants of ND outcome after repair of CHD at age ≤ 6 months. The subjects had previously undergone a ND evaluation (executive function, attention/impulsivity and social skills) at 4 years of age. For this study, subjects completed the RS-14, a questionnaire that captures the constructs of resilience; and the SF-36, a functional health status questionnaire. Factors associated with resilience were determined using generalized linear (gamma) regression. Results: The RS-14 and SF-36 were completed by 151 subjects (74 male and 77 female, mean age 19.5 ± 1.1 years). The median resilience score of 79 (CI 0.95 = 77, 82) was significantly greater than the young adult population median of 76.0, p = 0.006. Resilience was graded as moderate or higher in 103 subjects (68%). Higher resilience scores were significantly correlated with higher QOL assessed by the SF-36 Mental Component Summary, r = 0.40, p < 0.001. By simple regression, Caucasian race was associated with higher resilience scores, p = 0.03. Prematurity, low birth weight, presence of a genetic anomaly, and severity of CHD were not associated with higher or lower scores, all p > 0.2. No operative management factors were associated with higher or lower scores, all p > 0.28. Better performance for executive function ( p = 0.03) and social skills ( p = 0.02) at the 4-year ND evaluation were associated with higher resilience. Hyperactivity was associated with lower resilience scores, p = 0.02. Conclusions: Many young adults with CHD demonstrate good resilience. Higher resilience is associated with better QOL. Performance on ND testing in the preschool period may identify patients with lower resilience and offer an opportunity for intervention.