Clinical Outcome Score Predicts Adverse Neurodevelopmental Outcome After Infant Heart Surgery.
BACKGROUND
The purpose of this study was to determine whether a clinical outcome score derived from early postoperative events is associated with Bayley-III scores at 18 to 24 months among infants undergoing cardiopulmonary bypass surgery.


METHODS
Included were infants aged 6 weeks or less who underwent surgery between 2005 and 2009, all of whom were referred for neurodevelopmental evaluation at 18 to 24 months. We excluded children with chromosomal abnormalities. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal life support were assigned a score of 7.


RESULTS
One hundred and ninety-nine subjects were included. Surgical procedures were arterial switch (72), Norwood (60), repair of total anomalous pulmonary venous connection (29), and other (38). Nine subjects had postoperative extracorporeal life support. Mean clinical outcome score in the Norwood group was 4.0 ± 1.4 versus the arterial switch group (2.6 ± 1.5, p < 0.001), total anomalous pulmonary venous connection group (2.8 ± 1.8, p < 0.01), and other group (4.0 ± 1.8, p = not significant). Among children who had a clinical outcome score of 4 or greater, there was a decrease in Bayley-III cognitive score of 5.7 (95% confidence interval: 1.5 to 9.9, p = 0.009), a decrease in language score of 10.0 (95% confidence interval: 4.9 to 15.1, p < 0.001), and a decrease in motor score of 9.7 (95% confidence interval: 4.8 to 14.5, p < 0.001). Time until lactate of 2.0 mmol/L or less and highest 24-hour inotrope score increased with increasing clinical outcome score (p < 0.0001).


CONCLUSIONS
Clinical outcome scores of 4 or greater were associated with significantly lower Bayley-III scores at 18 to 24 months. This score may be valuable as an endpoint when evaluating novel potential therapies for this high-risk population.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada. Electronic address: andrew.mackie@ualberta.ca.
Andrew S
AS
Mackie
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Shabnam
S
Vatanpour
Stollery Children's Hospital, Edmonton, Alberta, Canada; Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada.
Gwen Y
GY
Alton
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Irina A
IA
Dinu
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada.
Lindsay
L
Ryerson
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
Diane M
DM
Moddemann
Department of Psychology, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada.
Julie
J
Thomas Petrie
D000416:Alberta / Q000453:epidemiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors