Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Atallah, Joseph; Dinu, Irina; Joffe, Ari R.; Robertson, Charlene M.T.; Sauvé, Reg; Dyck, John D.; Ross, David B.; Rebeyka, Ivan M.

doi:10.1161/circulationaha.107.741579

Cited by 88 publications

(32 citation statements)

References 49 publications

(46 reference statements)

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“…In contrast, Atallah et al did find a difference in PDI at 2 years between those treated with an RVPAS (mean PDI=78) and those with a MBTS (mean PDI=67). 22 This finding however was based on an observational cohort, with the shunt type changing by era, so that secular changes in other practices may have confounded this study finding.…”

Section: Discussionmentioning

confidence: 88%

Factors Associated with Neurodevelopment for Children with Single Ventricle Lesions

Goldberg

Lü

Sleeper

et al. 2014

The Journal of Pediatrics

109

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Objective To measure neurodevelopment at 3 years in children with single right ventricle anomalies and to assess its relationship to Norwood shunt type, neurodevelopment at 14 months, and patient and medical factors. Study design All subjects in the Single Ventricle Reconstruction Trial who were alive without cardiac transplant were eligible for inclusion. The Ages and Stages Questionnaire (ASQ, n=203) and other measures of behavior, and quality of life (QOL) were completed at age 3 years. Medical history, including measures of growth, feeding, and complications, was assessed through annual record review and phone interview. The Bayley Scales of Infant Development-II (BSID-II) scores from age 14 months were also evaluated as predictors. Results Scores on each ASQ domain were significantly lower than normal (p<0.001). ASQ domain scores at 3 years varied nonlinearly with 14-month BSID-II. More complications, abnormal growth, and evidence of feeding, vision, or hearing problems, were independently associated with lower ASQ scores, although models explained < 30% of variation. Shunt type was not associated with any ASQ domain score, or with behavior or QOL measures. Conclusion Children with SV have impaired neurodevelopment at 3 years. Lower ASQ scores are associated with medical morbidity, and lower BSID-II scores, but not with shunt type. However, because only a modest percentage of variation in 3-year neurodevelopmental outcome could be predicted from early measures, all children with SV should be followed longitudinally to improve recognition of delays.

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Section: Discussionmentioning

confidence: 88%

Factors Associated with Neurodevelopment for Children with Single Ventricle Lesions

Goldberg

Lü

Sleeper

et al. 2014

The Journal of Pediatrics

109

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“…7 Importantly, these studies have identified few modifiable risk factors for adverse neurodevelopmental outcomes. [7][8][9] In addition, these studies usually derive from single centers and are limited by small sample size.…”

Section: What This Study Addsmentioning

confidence: 99%

“…All invited investigators agreed to submit data for this analysis. 8,9,[15][16][17][18][19][20][21][22][23][24] …”

Section: Identification Of Participating Institutionsmentioning

confidence: 99%

Neurodevelopmental Outcomes After Cardiac Surgery in Infancy

et al. 2015

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, for the International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators abstract BACKGROUND: Neurodevelopmental disability is the most common complication for survivors of surgery for congenital heart disease (CHD). METHODS:We analyzed individual participant data from studies of children evaluated with the Bayley Scales of Infant Development, second edition, after cardiac surgery between 1996 and 2009. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI).RESULTS: Among 1770 subjects from 22 institutions, assessed at age 14.5 6 3.7 months, PDIs and MDIs (77.6 6 18.8 and 88.2 6 16.7, respectively) were lower than normative means (each P , .001). Later calendar year of birth was associated with an increased proportion of high-risk infants (complexity of CHD and prevalence of genetic/extracardiac anomalies). After adjustment for center and type of CHD, later year of birth was not significantly associated with better PDI or MDI. Risk factors for lower PDI were lower birth weight, white race, and presence of a genetic/extracardiac anomaly (all P # .01). After adjustment for these factors, PDIs improved over time (0.39 points/year, 95% confidence interval 0.01 to 0.78; P = .045). Risk factors for lower MDI were lower birth weight, male gender, less maternal education, and presence of a genetic/extracardiac anomaly (all P , .001). After adjustment for these factors, MDIs improved over time (0.38 points/year, 95% confidence interval 0.05 to 0.71; P = .02).CONCLUSIONS: Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved modestly over time, but only after adjustment for innate patient risk factors. As more high-risk CHD infants undergo cardiac surgery and survive, a growing population will require significant societal resources.

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“…In the Boston Circulatory Arrest Study, length of stay was independently associated with worse cognitive function at 8 years of age, even after adjustment for factors related to the length of stay (e.g., sepsis, low cardiac output) or cognitive outcomes (e.g., maternal education, socioeconomic status) (76). Virtually all studies reporting short and longer term neurodevelopmental outcomes have two consistent factors independently related to worse outcomes: increased length of stay and lower socioeconomic status (77, 80, 108–110). While some aspects of length of stay may not be modifiable, many units are now actively investigating strategies to reduce length of stay (e.g., timing of surgery, early extubation, minimizing delayed sternal closure, etc.)…”

Section: Length Of Staymentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

Wernovsky¹,

Licht²

2016

Pediatric Critical Care Medicine

201

143

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Objectives The objectives of this review are to discuss the scope of neurologic injuries in newborns with congenital heart disease, the mechanisms of injury, including pre-natal, pre- intra- and postoperative factors, neurodevelopmental outcomes and therapeutic strategies for the timely intervention and prevention of neurologic injury. Data Source MEDLINE, PubMed Conclusion At the current time, important research is underway to (1) better understand the developing brain in the fetus with complex congenital heart disease, (2) to identify modifiable risk factors in the operating room and intensive care unit in order to maximize long-term neurodevelopmental outcomes and (3) develop strategies to improve family psychosocial health, childhood development and health-related quality of life following hospital discharge. Crucial in this effort is the identification of an early post-operative surrogate variable with good predictive validity for long-term outcomes. If an appropriate surrogate variable for long term outcomes can be identified, and measured relatively early after surgical intervention for complex congenital heart disease, reliable clinical trials can be undertaken to improve upon current outcomes.

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Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Cited by 88 publications

References 49 publications

Factors Associated with Neurodevelopment for Children with Single Ventricle Lesions

Factors Associated with Neurodevelopment for Children with Single Ventricle Lesions

Neurodevelopmental Outcomes After Cardiac Surgery in Infancy

Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

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