Neurodevelopmental outcomes after cardiac surgery in infancy.
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 ± 3.7 months, PDIs and MDIs (77.6 ± 18.8 and 88.2 ± 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.
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; gaynor@email.chop.edu.
J William
JW
Gaynor
Boston Children's Hospital, Boston, Massachusetts;
Christian
C
Stopp
Boston Children's Hospital, Boston, Massachusetts;
David
D
Wypij
Texas Children's Hospital, Houston, Texas;
Dean B
DB
Andropoulos
Stollery Children's Hospital and the Western Canadian Complex Pediatric Therapies Follow-up Program, Edmonton, Alberta, Canada;
Joseph
J
Atallah
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina;
Andrew M
AM
Atz
Starship Children's Hospital, Auckland, New Zealand;
John
J
Beca
Children's National Medical Center, Washington, District of Columbia;
Mary T
MT
Donofrio
Children's Hospital and Medical Center, Omaha, Nebraska;
Kim
K
Duncan
Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;
Nancy S
NS
Ghanayem
Mott's Children's Hospital, Ann Arbor, Michigan;
Caren S
CS
Goldberg
University Hospital Aachen, Aachen, Germany;
Hedwig
H
Hövels-Gürich
Toyama University Hospital, Toyama, Japan;
Fukiko
F
Ichida
Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida;
Jeffrey P
JP
Jacobs
University of Queensland, Brisbane, Australia;
Robert
R
Justo
University Children's Hospital Zurich, Zurich, Switzerland;
Beatrice
B
Latal
Duke University Medical Center, Durham, North Carolina;
Jennifer S
JS
Li
Children's Healthcare of Atlanta, Atlanta, Georgia;
William T
WT
Mahle
University of California, San Francisco, San Francisco, California;
Patrick S
PS
McQuillen
Primary Children's Medical Center, Salt Lake City, Utah;
Shaji C
SC
Menon
National Heart, Lung, and Blood Institute, Bethesda, Maryland;
Victoria L
VL
Pemberton
Children's Hospital Los Angeles, Los Angeles, California;
Nancy A
NA
Pike
Alfred I. duPont Hospital for Children, Wilmington, Delaware;
Christian
C
Pizarro
The Royal Children's Hospital, Melbourne, Australia;
Lara S
LS
Shekerdemian
University of British Columbia, Vancouver, British Columbia, Canada; and.
Anne
A
Synnes
New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, New York.
Ismee
I
Williams
Boston Children's Hospital, Boston, Massachusetts;
David C
DC
Bellinger
Boston Children's Hospital, Boston, Massachusetts;
Jane W
JW
Newburger
D006348:Cardiac Surgical Procedures; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009420:Nervous System / Q000254:growth & development; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors
cardiac surgery; cardiopulmonary bypass; congenital heart defects; neurodevelopmental outcomes