Bilateral Sensory Permanent Hearing Loss After Palliative Hypoplastic Left Heart Syndrome Operation

Robertson, Charlene M.T.; Alton, Gwen Y.; Bork, Karin T.; Joffe, Ari R.; Tawfik, Gerda; Sauvé, Reg; Moddemann, Diane; Rebeyka, Ivan M.

doi:10.1016/j.athoracsur.2011.08.042

Cited by 16 publications

(15 citation statements)

References 27 publications

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“…33 The frequency of permanent hearing impairment among those with CND and those without was similar in our study; this may have been associated to ototoxicity as previously reported. 6 …”

Section: Prediction Of Cndmentioning

confidence: 99%

“…Survival rates after complex cardiac surgery (CCS) in early infancy have increased. 1 Disabilities have become a concern as studies show children with Congenital Heart Disease (CHD) often demonstrate deficits in cognitive abilities, social interaction, 2,3 language, 4 behavior, 5 permanent hearing loss, 6 and healthrelated quality of life. 7 Neuromotor delays have also been described as possible long-term outcomes after cardiac surgery 4,8,9 ; and acquired brain injury (ABI) has been recognized as a complication.…”

Section: What This Study Addsmentioning

confidence: 99%

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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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“…33 The frequency of permanent hearing impairment among those with CND and those without was similar in our study; this may have been associated to ototoxicity as previously reported. 6 …”

Section: Prediction Of Cndmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Ricci¹,

Andersen

Joffe

et al. 2015

Pediatrics

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“…Inner ear ischemia and hypo perfusion are the main proven physiological mechanisms for hearing loss after open heart surgery [11][12]. Hypoxia and bolus administration of furosemide have been reported to be significant risk factors for hearing loss in children after cardiopulmonary bypass surgery [7]. The duration of ECMO therapy and clinical seizure activity prior to ECMO are independently associated with SNHL [13].…”

Section: Discussionmentioning

confidence: 99%

“…Very few studies, however, have attempted to estimate the prevalence of SNHL in children who have undergone congenital heart surgery. Of these studies, one old study estimated the prevalence to be 16% in CHD patients [6], and a recent study estimated the prevalence to be as high as 28.6% among childhood survivors after the Norwood/Sano operation only [7]. Currently, no clear recommendations exist for audiology screening in patients undergoing repair or palliation of CHD.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Sensorineural Hearing Loss in Children with Palliated or Repaired Congenital Heart Disease

Gopineti

Paulpillai²,

Rosenquist³

et al. 2020

Cureus

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Background Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental deficits, and the presence of sensorineural hearing loss (SNHL) may further lead to poor language skills acquisition and speech delays. Prevalence of SNHL in the general pediatric population is estimated to be 0.2% at birth to 0.35% during adolescence. Very few studies have attempted to estimate SNHL prevalence in children who have undergone congenital heart surgery. Methods This retrospective study aimed to estimate SNHL prevalence in children who underwent congenital heart surgery in our institution and were followed up in our high-risk pediatric cardiology clinics for four years from 2009 to 2013. Data were collected on demographics, preoperative variables, surgical variables, and post-operative variables. Results SNHL prevalence in asymptomatic, palliated/repaired CHD patients followed in our high-risk clinics and undergoing routine surveillance was 11.6% (20 of 172 patients with hearing impairment). SNHL prevalence was not statistically higher in single-ventricle patients (17.2%) compared to biventricular patients (14.7%). Inotropic score in the first 24 hours of postoperative period (p=0.05), lowest arterial PaO2 (p=0.003), duration of Lasix drip (p=0), and bolus dose in days (p=0.03) were all found to be statistically significant in the hearing-impaired group. However, using logistic regression, we identified no statistically significant predictors for hearing loss. Conclusion The results suggest the need for routine audiology screening of all patients with complex CHD, especially those who have undergone neonatal cardiac repair/palliation at less than one year of age, irrespective of risk factors.

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“…7 Many of these also occur in children with CHD, including prolonged intensive care, assisted ventilation, Extracorporeal Membrane Oxygenation (ECMO), and exposure to ototoxic medications. 8–13 HL and its impact on neurodevelopmental indicators have not been explicitly studied in children with different types of CHD, including those undergoing surgical repair.…”

mentioning

confidence: 99%