title: Neurodevelopmental outcomes after open heart operations before 3 months of age.
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.
authors.affiliation: Labatt Family Heart Centre and Division of Neurology, Department of Paediatrics, Surgery and Critical Care Medicine, The University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada. renee.sananes@sickkids.ca
authors.forename: Renée
authors.initials: R
authors.lastname: Sananes
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Edmond
authors.initials: E
authors.lastname: Kelly
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Hornberger
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Daune
authors.initials: D
authors.lastname: MacGregor
authors.forename: Raymond
authors.initials: R
authors.lastname: Buncic
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D002657:Child Development / Q000502:physiology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D019957:Motor Skills Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D009483:Neuropsychological Tests; D009864:Ontario; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome