Neurodevelopmental outcomes after open heart operations before 3 months of age

Renée Sananes, Cedric Manlhiot, Edmond Kelly, Lisa K. Hornberger, William G. Williams, Daune MacGregor, Raymond Buncic, Brian W. McCrindle

Research output: Contribution to journalArticle

Abstract

Background: The purpose of this study was to monitor developmental progress and identify predictors of developmental outcomes at 2 years after operation in infants who underwent a surgical procedure with cardiopulmonary bypass (CPB) at less than 3 months of age. Methods: Patients (N = 131 enrolled; N = 106 assessed) less than 3 months of age at the time of cardiac operation were prospectively enrolled (years 1999-2003) and assessed at 8, 12, and 24 months after operation. Patients with preexisting conditions independently associated with poor neurodevelopmental outcomes were excluded. Fine and gross motor development was formally assessed at all 3 visits, and parent ratings of development across several domains were obtained. Neurodevelopment was formally assessed at 24 months of age using the Bayley Scales of Infant Development, 2nd edition (BSID-II) Mental Development Index score (MDI). Results: Significant gross motor difficulties were identified at 8 months of age (p < 0.001) and, although improved by the 24-month assessment, remained lower than average. Fine motor skills showed a significant decrease from 8 to 24 months of age (p = 0.001). Factors associated with poorer neurodevelopmental outcome (BSID-II MDI) at 24 months after operation included a diagnosis of univentricular anatomy or complex coarctation of the aorta, higher complexity of the surgical procedure, longer duration of hospital stay, and presence of complications in the postoperative period. Conclusions: Children undergoing repair of congenital heart disease (CHD) still have impaired development 2 years after the operation. Observed patterns of development were specific to the skill being assessed and related to both anatomic complexity and increased complexity of care received.

Original languageEnglish (US)
Pages (from-to)1577-1583
Number of pages7
JournalAnnals of Thoracic Surgery
Volume93
Issue number5
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Preexisting Condition Coverage
Motor Skills
Aortic Coarctation
Child Development
Cardiopulmonary Bypass
Postoperative Period
Heart Diseases
Length of Stay
Anatomy

Keywords

  • Ages & Stages Questionnaire
  • ASQ
  • Bayley Scales of Infant Development, 2nd edition
  • BSIDII
  • cardiopulmonary bypass
  • CHD
  • congenital heart disease
  • CPB
  • MDI
  • Mental Development Index
  • PDMS
  • Peabody Developmental Motor Scales
  • RACHS
  • risk adjustment for congenital heart surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Sananes, R., Manlhiot, C., Kelly, E., Hornberger, L. K., Williams, W. G., MacGregor, D., ... McCrindle, B. W. (2012). Neurodevelopmental outcomes after open heart operations before 3 months of age. Annals of Thoracic Surgery, 93(5), 1577-1583. https://doi.org/10.1016/j.athoracsur.2012.02.011

Neurodevelopmental outcomes after open heart operations before 3 months of age. / Sananes, Renée; Manlhiot, Cedric; Kelly, Edmond; Hornberger, Lisa K.; Williams, William G.; MacGregor, Daune; Buncic, Raymond; McCrindle, Brian W.

In: Annals of Thoracic Surgery, Vol. 93, No. 5, 01.05.2012, p. 1577-1583.

Research output: Contribution to journalArticle

Sananes, R, Manlhiot, C, Kelly, E, Hornberger, LK, Williams, WG, MacGregor, D, Buncic, R & McCrindle, BW 2012, 'Neurodevelopmental outcomes after open heart operations before 3 months of age', Annals of Thoracic Surgery, vol. 93, no. 5, pp. 1577-1583. https://doi.org/10.1016/j.athoracsur.2012.02.011
Sananes, Renée ; Manlhiot, Cedric ; Kelly, Edmond ; Hornberger, Lisa K. ; Williams, William G. ; MacGregor, Daune ; Buncic, Raymond ; McCrindle, Brian W. / Neurodevelopmental outcomes after open heart operations before 3 months of age. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 5. pp. 1577-1583.
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AU - Sananes, Renée

AU - Manlhiot, Cedric

AU - Kelly, Edmond

AU - Hornberger, Lisa K.

AU - Williams, William G.

AU - MacGregor, Daune

AU - Buncic, Raymond

AU - McCrindle, Brian W.

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AB - Background: The purpose of this study was to monitor developmental progress and identify predictors of developmental outcomes at 2 years after operation in infants who underwent a surgical procedure with cardiopulmonary bypass (CPB) at less than 3 months of age. Methods: Patients (N = 131 enrolled; N = 106 assessed) less than 3 months of age at the time of cardiac operation were prospectively enrolled (years 1999-2003) and assessed at 8, 12, and 24 months after operation. Patients with preexisting conditions independently associated with poor neurodevelopmental outcomes were excluded. Fine and gross motor development was formally assessed at all 3 visits, and parent ratings of development across several domains were obtained. Neurodevelopment was formally assessed at 24 months of age using the Bayley Scales of Infant Development, 2nd edition (BSID-II) Mental Development Index score (MDI). Results: Significant gross motor difficulties were identified at 8 months of age (p < 0.001) and, although improved by the 24-month assessment, remained lower than average. Fine motor skills showed a significant decrease from 8 to 24 months of age (p = 0.001). Factors associated with poorer neurodevelopmental outcome (BSID-II MDI) at 24 months after operation included a diagnosis of univentricular anatomy or complex coarctation of the aorta, higher complexity of the surgical procedure, longer duration of hospital stay, and presence of complications in the postoperative period. Conclusions: Children undergoing repair of congenital heart disease (CHD) still have impaired development 2 years after the operation. Observed patterns of development were specific to the skill being assessed and related to both anatomic complexity and increased complexity of care received.

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