title: Clinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery.
abstract: OBJECTIVE
  Our goal was to determine if a clinical outcome score derived from early postoperative events is associated with 18- to 24-month Psychomotor Developmental Index (PDI) score among infants undergoing cardiopulmonary bypass surgery.
  
  
  METHODS
  We included infants aged ≤6 weeks who underwent surgery during 2002-2006, all of whom were referred for neurodevelopmental evaluation at age 18 to 24 months. We excluded children with chromosomal abnormalities, hearing loss, cerebral palsy, or a Bayley III assessment. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal membrane oxygenation were assigned a score of 7.
  
  
  RESULTS
  Ninety-nine subjects were included. Surgical procedures were arterial switch (n = 36), Norwood (n = 26), repair of total anomalous pulmonary venous connection (n = 16), and other (n = 21). Four subjects had postoperative extracorporeal membrane oxygenation. Clinical outcome scores were highest in the Norwood group (mean 4.1 ± 1.4) compared with the arterial switch group (1.9 ± 1.6) (P < .001), total anomalous pulmonary venous connection group (1.6 ± 2.0) (P < .001), and other group (3.3 ± 1.6, P = not significant). A mean decrease in PDI of 10.9 points (95% confidence interval, 4.9-16.9; P = .0005) was observed among children who had a clinical outcome score ≥3, compared with those with a clinical outcome score <3. Time until lactate ≤2.0 mmol/L increased with increasing clinical outcome score (P = .0003), as did highest 24-hour inotrope score (P < .0001).
  
  
  CONCLUSIONS
  Clinical outcome scores of ≥3 were associated with a significantly lower PDI at age 18 to 24 months. This score may be valuable as an end point when evaluating novel potential therapies for this high-risk population.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. andrew.mackie@ualberta.ca
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Mackie
authors.forename: Gwen Y
authors.initials: GY
authors.lastname: Alton
authors.forename: Irina A
authors.initials: IA
authors.lastname: Dinu
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Charlene M T
authors.initials: CM
authors.lastname: Robertson
mesh_terms: D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D007902:Length of Stay; D016014:Linear Models; D009420:Nervous System / Q000254:growth & development / Q000503:physiopathology*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D019344:Lactic Acid