title: Long-Term Neurodevelopmental Outcome of Children Treated with Tri-Iodothyronine after Cardiac Surgery: Follow-Up of a Double-Blind, Randomized, Placebo-Controlled Study.
abstract: BACKGROUND
  Transient thyroid dysfunction occurs in children after cardiopulmonary bypass (CPB). We demonstrated significant benefits of acute postoperative tri-iodothyronine (T3) treatment for recovery and myocardial function. Now we report the long-term neurodevelopment of these children.
  
  
  METHODS
  Twenty-eight children (70% of the original study population) could be recruited for a follow-up examination (median age 10.7 years, range 10-19.6 years) retaining the double-blind, randomized, placebo-controlled protocol. Cognitive function and motor development were tested, as were growth and thyroid and cardiac functions.
  
  
  RESULTS
  The median full-scale intelligence quotient of all children was within the reference range and similar in the placebo and T3 groups. Tests for motor and cognitive functions, growth, and thyroid and cardiac functions revealed concurrent results.
  
  
  CONCLUSIONS
  Overall intellectual development is preserved in adolescents treated with CPB in infancy irrespectively of low postoperative thyroid hormone concentrations. While acute postoperative T3 treatment in children after CPB improves recovery, no significant long-term effects on neurodevelopment could be detected. We therefore speculate that transient postoperative thyroid dysfunction by means of nonthyroidal illness syndrome is predominantly mediated by extranuclear, nongenomic mechanisms and thus acutely affects the cardiovascular system but not the development of the central nervous system mediated by genomic mechanisms.
authors.affiliation: Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Janna
authors.initials: J
authors.lastname: Mittnacht
authors.forename: Daniela
authors.initials: D
authors.lastname: Choukair
authors.forename: Carolin
authors.initials: C
authors.lastname: Kneppo
authors.forename: Romuald
authors.initials: R
authors.lastname: Brunner
authors.forename: Peter
authors.initials: P
authors.lastname: Parzer
authors.forename: Matthias
authors.initials: M
authors.lastname: Gorenflo
authors.forename: Markus
authors.initials: M
authors.lastname: Bettendorf
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002657:Child Development; D003071:Cognition; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D009048:Motor Skills; D009420:Nervous System / Q000254:growth & development*; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology; D013959:Thyroid Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D014284:Triiodothyronine / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014284:Triiodothyronine