title: Risk factors for neurodevelopmental impairments in school-age children after cardiac surgery with full-flow cardiopulmonary bypass.
abstract: OBJECTIVE
  To determine the risk factors for adverse neurodevelopmental outcomes in school-age children after full flow open-heart surgery for congenital heart disease.
  
  
  METHODS
  The outcome was assessed in 117 children without a genetic comorbidity at a mean age of 10.4 ± 2.5 years. Intelligence was assessed using the Raven's Progressive Matrices and neuromotor function using the Zurich Neuromotor Assessment. Risk factors were retrieved from detailed chart review.
  
  
  RESULTS
  The mean intelligence score was 89 ± 16, significantly lower than the norm (P < .001). Cerebral palsy was diagnosed in 10% of patients. Poor neuromotor performance (less than p10) was present in 15% to 20% of the children, depending on the motor task (all P < .001). Pure motor and static balance performance was also significantly impaired when patients with cerebral palsy were excluded (P < .01). Intelligence was only related to socioeconomic status (P = .006), and neuromotor outcome was related to the length of hospital stay and postoperative neurologic abnormalities (P < .03). The extracorporeal circulation time was related to adaptive fine motor performance (P = .05). All other variables were not related to outcome.
  
  
  CONCLUSIONS
  Children without a genetic comorbidity are at risk of long-term intellectual and motor impairments also after full-flow cardiac repair. Surgery-related parameters play a less important role for adverse outcomes than postoperative complications. Our findings stress the importance of specialized follow-up assessments for all children with CHD undergoing open heart surgery.
authors.affiliation: Child Development Center, Children's Hospital, Zurich, Switzerland. Michael.vonrhein@kispi.uzh.ch
authors.forename: Michael
authors.initials: M
authors.lastname: von Rhein
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dimitropoulos
authors.forename: Emanuela R
authors.initials: ER
authors.lastname: Valsangiacomo Buechel
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
authors.forename: Beatrice
authors.initials: B
authors.lastname: Latal
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002547:Cerebral Palsy / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D002648:Child; D002657:Child Development; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D007360:Intelligence; D007361:Intelligence Tests; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D009420:Nervous System / Q000254:growth & development*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D004856:Postural Balance; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013557:Switzerland; D013997:Time Factors