title: Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5-Year Neurocognitive Outcomes.
abstract: BACKGROUND
  We aimed to determine whether sepsis is associated with neurocognitive outcomes 4.5 years after congenital heart disease surgery in early infancy.
  
  
  RESULTS
  A secondary analysis from a prospective inception cohort included all children having congenital heart disease surgery done at ≤6 weeks of age with cardiopulmonary bypass at the Western Canadian referral center from 1996 to 2009. Follow-up at the referral center determined the primary outcomes at 4.5 years with full-scale, performance, and verbal intelligence quotients on the Wechsler Preschool and Primary Scale of Intelligence. Perioperative variables were collected prospectively, and confirmation of blood culture-positive sepsis was done retrospectively. Multiple linear regression models for neurocognitive outcomes and multiple Cox proportional hazards regression for mortality were determined. Sepsis occurred in 97 of 502 patients (19%) overall and in 76 of 396 survivors (19%) with 4.5-year follow-up. By 4.5 years, there were 91 (18%) deaths, and 396 of 411 survivors (96%) had follow-up completed. Extracorporeal membrane oxygenation was associated with worse scores on all neurocognitive outcomes on multivariable regression; the association between extracorporeal membrane oxygenation and full-scale intelligence quotient had a regression coefficient of -13.6 (95% CI -21.3 to -5.9; P=0.001). Sepsis perioperatively was associated with performance and verbal intelligence quotients, with a trend for full-scale intelligence quotient (P=0.058) on multivariable regression. The regression coefficient for sepsis was strongest for performance intelligence quotient (-5.31; 95% CI -9.84 to -0.78; P=0.022). Sepsis was not but extracorporeal membrane oxygenation was associated with mortality by 4.5 years.
  
  
  CONCLUSIONS
  Perioperative sepsis and extracorporeal membrane oxygenation were associated with adverse neurocognitive outcomes on multivariable regression. Quality improvement to prevent sepsis has the potential to improve long-term neurocognitive outcomes in infants after surgery for congenital heart disease.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada (N.S., A.R.J.).
authors.forename: Naveen
authors.initials: N
authors.lastname: Sidhu
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada (N.S., A.R.J.).
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Calgary, Alberta, Canada (P.D.).
authors.forename: Paul
authors.initials: P
authors.lastname: Doughty
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada (S.V., I.D.).
authors.forename: Shabnam
authors.initials: S
authors.lastname: Vatanpour
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada (S.V., I.D.).
authors.forename: Irina
authors.initials: I
authors.lastname: Dinu
authors.affiliation: Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada (G.A.).
authors.forename: Gwen
authors.initials: G
authors.lastname: Alton
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (B.A.).
authors.forename: Bryan
authors.initials: B
authors.lastname: Acton
authors.affiliation: Pediatric Rehabilitation Outcomes Evaluation and Research Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada (C.T.R.).
authors.forename: Charlene M T
authors.initials: CM
authors.lastname: Robertson
mesh_terms: D000367:Age Factors; D002170:Canada; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002657:Child Development; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007360:Intelligence; D007361:Intelligence Tests; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009420:Nervous System / Q000254:growth & development*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology
keywords: congenital; extracorporeal circulation; heart defects; infection; morbidity; risk factors