Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery

Limperopoulos, Catherine; Majnemer, Annette; Shevell, Michael; Rosenblatt, Bernard; Rohlicek, Charles V.; Tchervenkov, Christo I.

doi:10.1067/mpd.2000.109152

Cited by 247 publications

(207 citation statements)

References 29 publications

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“…4 Neurological abnormalities such as muscular hypotonia are frequent in children with congenital heart disease and are often diagnosed before cardiac surgery. 22 Among those neurobehavioural abnormalities was also an absent suck or poor feeding efficiency. 15,22 Thus, concurrent perioperative neurological abnormalities can contribute to the development of feeding disorders as a constitutional, independent factor.…”

Section: Discussionmentioning

confidence: 99%

“…22 Among those neurobehavioural abnormalities was also an absent suck or poor feeding efficiency. 15,22 Thus, concurrent perioperative neurological abnormalities can contribute to the development of feeding disorders as a constitutional, independent factor. In conclusion, children born with a severe cardiac defect who require cardiac surgery within the first month of life are at increased risk of developing a feeding disorder at 2 years of age.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease

et al. 2011

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Aim: We thought of assessing the prevalence and predictors of feeding disorders in patients with congenital heart defects after neonatal cardiac surgery. Methods: Retrospective study of 82 consecutive neonates (48 males, 34 females) who underwent surgery for congenital heart defects from 1999 to 2002. Information was taken from patient charts and nursing notes. The presence of a feeding disorder was assessed by a questionnaire sent to the paediatricians when the child was 2 years of age. A feeding disorder was defined as a need for tube feeding, inadequate food intake for age, or failure to thrive. Data were analysed with descriptive statistics and logistic regression. Results: Feeding disorders occurred in 22% of the study population. Reoperation and early feeding disorders were identified as independent risk factors for later feeding disorders (odds ratio 5.8, p 0.01; odds ratio 20.7, p 0.02). There was a trend towards more feeding disorders in patients with neurological abnormalities during the first hospital stay. Conclusion: Feeding disorder is a frequent, long-term sequela after neonatal cardiac surgery. Patients with congenital heart defects who undergo multiple cardiac surgeries and those with early feeding disorders are at risk of developing later feeding disorders. Patients with these risk factors need to be selected for preventive strategies. is a complex condition involving different symptoms, such as food refusal and faddiness, and leading to a decreased food intake. 1 It often results from abnormal feeding development. A child's feeding development is determined by its constitution, the environment, and the child's learning process. 2 Pathology in one or more of these components can lead to a feeding disorder. Factors of constitutional origin can be organic diseases, such as the malformation of organs directly related to food intake or transport, or diseases of other organ systems that disturb the child's feeding and digestion process by impacting on its general health. 3 Disorders of the central nervous system can also contribute to the development of feeding problems. 4 The child's environment is defined by the parents' behaviour and the family's cultural and social background. Any imbalance between parental expectations and the child's feeding progress could cause an interaction problem, generating feeding disorders, such as food refusal, avoidance or aversion, on the part of the child. Parents with psychological disorders, or uncertainty regarding feeding style in families from other cultures, and also poverty and poor education can be contributory factors to feeding disorders. In most patients with feeding disorders, it is typically a combination of different factors that gives rise to the disorder. [5][6][7][8][9][10][11] Although some children start with a purely organic problem, that is, constitutional, many

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease

et al. 2011

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“…Factors such as degree of previous heart insufficiency and degree of cyanosis (in newborns, saturation <85% was significantly associated with abnormalities) 27 could have explained the difference found, yet they were not assessed.…”

Section: Statistical Analysis and Data Processingmentioning

confidence: 93%

“…Delay prevalence is estimated to be at 38% 27 . In our population it was even higher, reaching 75% of the children prior to the surgery.…”

Section: Statistical Analysis and Data Processingmentioning

confidence: 99%

“…It is important to point out the validity of trans-operative and pos-operative measures for neurological outcome. A large number of studies state that bypass time is one of the main factors associated with untoward neurological outcomes, given that the higher the likelihood of embolisms, and deregulation caused by hypothermia, the higher the inflammatory and metabolic activity 27 . Another trans-operative factor that is often cited in the literature is the correction or not of the pH by the temperature.…”

Section: Statistical Analysis and Data Processingmentioning

confidence: 99%

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Neuropsychomotor development before and after open-heart surgery in infants

Rocha

Guardiola

Piva

et al. 2009

Arq. Neuro-Psiquiatr.

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-There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67±23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.Key WorDs: cardiac surgery, developmental delay, Denver II test.desenvolvimento neuropsicomotor de lactentes antes e após cirurgia cardíaca resumo -As alterações neurológicas em lactentes com cardiopatia congênita podem agravar seu quadro clínico e levar a seqüelas permanentes. Foi realizada uma coorte prospectiva, com 20 lactentes, com idade média de 6,7±4,2 meses, avaliando-se o perfil de desenvolvimento e o estado nutricional. Utilizou-se o exame neurológico e o teste de Denver II. os testes foram aplicados 24h antes da cirurgia, na alta da unidade de terapia intensiva e 3 a 6 meses após. os defeitos septais ocorreram em 11 casos (55%). o tempo médio de circulação extra-corpórea foi de 67±23,6 minutos. Quinze crianças tinham exame neurológico alterado e atraso no desenvolvimento neuropsicomotor antes da cirurgia, cuja normalização foi observada somente em seis após 6 meses .Quanto aos índices de Denver II, houve aumento em todos domínios, exceto o pessoalsocial. o escore Z médio para peso antes da cirurgia foi -2,814±1,98 e após -1,08±1,47 (p<0.05), o qual foi realizado em média 5.2±1.5 meses após a alta hospitalar. Melhora precoce tanto no desenvolvimento como no estado nutricional pôde ser observada neste grupo de lactentes após a correção cirúrgica.PAlAvrAs-cHAve: cirurgia cardíaca, atraso no desenvolvimento neurológico, teste de Denver II, cardiopatia congênita. corrective cardiac surgery involves a series of complex and high risk procedures and a large number of them expose the brain to hypoxic ischemic insults 1 . Prospective studies have shown that 100% of children who undergo cardiac surgery present with central nervous system dysfunctions in the immediate post-operative period 2 as a consequence of alterations in the cerebral blood flow. If the hypoxic ischemic insult is acute and extensive, the patients may not regain consciousness in the immediate post-operative period and stand increased chances of irreversible sequelae. some of the neurological findings that may be observed are seizures, alterations of consciousness, behavioral disorders, intellectual impairment, focal deficit, involuntary movements, and lesions to the periph-

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2003

The Natural and Modifed History of Congenital Heart Disease

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Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery

Cited by 247 publications

References 29 publications

Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease

Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease

Neuropsychomotor development before and after open-heart surgery in infants

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