Neuro-developmental outcome in single-ventricle patients: is the Norwood procedure a risk factor?

Rotermann, Ina; Logoteta, Jana; Falta, Janine; Wegner, Philip; Jung, Olaf; Dütschke, Peter; Scheewe, Jens; Kramer, Hans‐Heiner; Hansen, Jan Hinnerk

doi:10.1093/ejcts/ezx119

Cited by 11 publications

(14 citation statements)

References 25 publications

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“…Our finding that HC at birth is an important predictor of IQ confirms previous studies that have demonstrated a relationship between poor fetal head growth 35 or small HC at birth and neurodevelopmental outcome in early childhood, 6,10,13,15,16,18 pre-school age, 11,17 and adolescence. 14 There is consistent evidence that intrauterine brain growth is altered in children with complex CHD, starting at around 30 weeks gestation, 29 resulting in smaller HC and smaller brain volumes at birth.…”

Section: Discussionsupporting

confidence: 91%

“…38 We found postoperative ICU stay to strongly predict IQ. This potentially modifiable risk factor has been identified by many studies, 10,17,39 and may be a surrogate marker for surgical and postoperative complexity with negative impact on later neurodevelopmental outcome. 20 A variety of other risk factors for poor IQ have been identified in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…5 Prenatal onset of poor growth may occur and has been linked to abnormal hemodynamic state. 9 Small preoperative HC and poor postnatal head growth is related to impaired neurodevelopmental outcome from early childhood until adolescence in biventricular (10)(11)(12)(13)(14) [10][11][12][13][14] and univentricular (6,(15)(16)(17)(18) 6,[15][16][17][18] types of CHD undergoing cardiopulmonary bypass surgery (CPB). Results for weight and height are conflicting.…”

Section: Introductionmentioning

confidence: 99%

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Growth and Intellectual Abilities of Six-Year-Old Children with Congenital Heart Disease

Heye

Rousson

Knirsch

et al. 2019

The Journal of Pediatrics

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OBJECTIVE To determine growth and its relationship to IQ in children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery within the first year of life. STUDY DESIGN Prospective single-center cohort study on 143 children (91 males) with different types of CHD (29 univentricular). Children with recognized genetic disorders were excluded. Growth (weight, height, and head circumference [HC]) was assessed at birth, before surgery, and at 1, 4, and 6 years and compared with Swiss growth charts. IQ was assessed at 6 years using standardized tests. Univariate and multivariable linear regressions were performed to determine predictors of HC and IQ at 6 years. RESULTS HC at birth was in the low average range (33rd percentile, P = .03), and weight (49th percentile, P = .23) and length (47th percentile, P = .06) were normal. All growth measures declined until the first surgery, with a catch-up growth until 6 years for height (44th percentile, P = .07) but not for weight (39th percentile, P = .003) or for HC (23rd percentile, P < .001). Children undergoing univentricular palliation showed poorer height growth than other types of CHD (P = .01). Median IQ at 6 years was 95 (range 50-135). Lower IQ at 6 years was independently predicted by lower HC at birth, lower socioeconomic status, older age at first bypass surgery, and longer length of intensive care unit stay. CONCLUSIONS Smaller HC at birth and postnatal factors are predictive of impaired intellectual abilities at school age. Early identification should alert clinicians to provide early childhood interventions to optimize developmental potential. AbstractObjective: To determine growth and its relationship to IQ in children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery within the first year of life. Study Design:Prospective single-center cohort study on 143 children (91 males) with different types of CHD (29 univentricular). Children with recognized genetic disorders were excluded. Growth (weight, height and head circumference (HC)) was assessed at birth, before surgery, at one, four and six years and compared to Swiss growth charts. IQ was assessed at six years using standardized tests.Univariate and multivariable linear regressions were performed to determine predictors of HC and IQ at six years.Results: HC at birth was in the low average range (33 th percentile, p=0.03), while weight (49 th percentile, p=0.23) and length (47 th percentile, p=0.06) were normal. All growth parameters declined until the first surgery, with a catch-up growth until six years for height (44 th percentile, p=0.07) but not for weight (39 th percentile, p=0.003) or for HC (23 th percentile, p<0.001). Children undergoing univentricular palliation showed poorer height growth than other types of CHD (p=0.01). Median IQ at six years was 95 (range 50 to 135). Lower IQ at six years was independently predicted by lower HC at birth, lower socioeconomic status, older age at first bypass surgery, and longer length of intensive care unit stay. Concl...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Growth and Intellectual Abilities of Six-Year-Old Children with Congenital Heart Disease

Heye

Rousson

Knirsch

et al. 2019

The Journal of Pediatrics

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“…For example, much research has been done on children undergoing cardiac surgery on CPB, and many have found that certain on‐pump procedures are linked to increased risk of stroke, cerebral changes, cognitive impairment, and/or neurodevelopmental disability 39‐44 . However, the literature is not unanimous on this topic either, and some studies have reported no increased risk of neurodevelopmental impairment after such procedures 45 . Postoperative movement disorders like chorea have also been reported following CPB, and may be related to on‐pump time 46‐49 .…”

Section: Discussionmentioning

confidence: 99%

The relationship between neurocognitive decline and the heart‐lung machine

2020

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Surgery involving the use of cardiopulmonary bypass (CPB) has long been associated with cerebral changes and may also contribute to adverse neurocognitive outcomes. However, there is a debate as to whether bypass itself is responsible for these changes. We conducted a systematic literature review on PubMed, supplementing our work with recent articles from other sources to examine the current evidence on neurocognitive decline associated with CPB. While surgeries

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“…1 Developmental problems, including cognitive impairment, fine and gross motor deficits, and speech and language disorders, are common especially in children with complex CHD requiring corrective or palliative surgery during the neonatal period. [1][2][3][4] However, cognitive abnormalities, often to a milder degree, are also found in children with less complex CHD undergoing surgery beyond the neonatal period. 1,[5][6][7][8] Developmental impairment observed in children with CHD is multifactorial and is influenced by nonmodifiable patient-specific factors and potentially modifiable factors including surgical technique and perioperative care.…”

Section: Introductionmentioning

confidence: 99%

S100B and its relation to cerebral oxygenation in neonates and infants undergoing surgery for congenital heart disease

Hansen

Kissner

Logoteta

et al. 2019

Congenital Heart Disease

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Objectives: Neonates and infants undergoing surgery for congenital heart disease are at risk for developmental impairment. Hypoxic-ischemic brain injury might be one contributing factor. We aimed to investigate the perioperative release of the astrocyte protein S100B and its relation to cerebral oxygenation.Methods: Serum S100B was measured before and 0, 12, 24, and 48 hours after surgery. Cerebral oxygen saturation was derived by near-infrared spectroscopy. S100B reference values based on preoperative samples; concentrations above the 75th percentile were defined as elevated. Patients with elevated S100B at 24 or 48 hours were compared to cases with S100B in the normal range. Neonates (≤28 days) and infants (>28 and ≤365 days) were analyzed separately due to age-dependent release of S100B.Results: Seventy-four patients underwent 94 surgical procedures (neonates, n = 38;infants, n = 56). S100B concentrations were higher in neonates before and after surgery at all time points (P ≤ .015). Highest values were noticed immediately after surgery. Postoperative S100B was elevated after 15 (40.5%) surgeries in neonates.There was no difference in pre-, intra-, or postoperative cerebral oxygenation. In infants, postoperative S100B was elevated after 23 (41.8%) procedures. Preoperative cerebral oxygen saturations tended to be lower (53 ± 12% vs 59 ± 12%, P = .069) and arterial-cerebral oxygen saturation difference was higher (35 ± 11% vs 28 ± 11%, P = .018) in infants with elevated postoperative S100B. In the early postoperative course, cerebral oxygen saturation was lower (54 ± 13% vs 63 ± 12%, P = .011) and arterial-cerebral oxygen saturation difference was wider (38 ± 11% vs 30 ± 10%, P = .008). Cerebral oxygen saturation was also lower for the entire postoperative course (62 ± 18% vs 67 ± 9%, P = .047). Conclusions:Postoperative S100B was elevated in about 40% of neonates and infants undergoing cardiac surgery. Infants with elevated postoperative S100B had impaired perioperative cerebral tissue oxygenation. No relation between S100B and cerebral oxygenation could be demonstrated in neonates. K E Y W O R D Sbrain biomarkers, cardiopulmonary bypass, cerebral protection, near-infrared spectroscopy

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Neuro-developmental outcome in single-ventricle patients: is the Norwood procedure a risk factor?

Cited by 11 publications

References 25 publications

Growth and Intellectual Abilities of Six-Year-Old Children with Congenital Heart Disease

Growth and Intellectual Abilities of Six-Year-Old Children with Congenital Heart Disease

The relationship between neurocognitive decline and the heart‐lung machine

S100B and its relation to cerebral oxygenation in neonates and infants undergoing surgery for congenital heart disease

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