title: Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life.
abstract: OBJECTIVE
  Little is known about chronic neuromotor disability (CND) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery (CCS). We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors.
  
  
  METHODS
  This prospective follow-up study included 549 children after CCS requiring cardiopulmonary bypass at ≤6 weeks of age. Groups included those with only 1 CCS, mostly biventricular CHD, and those with >1 CCS, predominantly single ventricle defects. At 4.5 years of age, 420 (94.6%) children received multidisciplinary assessment. Frequency of CND is given as percentage of assessed survivors. Predictors of CND were analyzed using multiple logistic regression analysis.
  
  
  RESULTS
  CND occurred in 6% (95% confidence interval [CI] 3.7%-8.2%) of 4.5-year survivors; for 1 CCS, 4.2% (CI 2.3%-6.1%) and >1, 9.8% (CI 7%-12.6%). CND presentation showed: hemiparesis, 72%; spasticity, 80%; ambulation, 72%; intellectual disability, 44%; autism, 16%; epilepsy, 12%; permanent vision and hearing impairment, 12% and 8%, respectively. Overall, 32% of presumed causative events happened before first CCS. Independent odds ratio for CND are age (days) at first CCS, 1.08 (CI 1.04-1.12; P < .001); highest plasma lactate before first CCS (mmol/L), 1.13 (CI 1.03-1.23; P = 0.008); and >1 CCS, 3.57 (CI 1.48-8.9; P = .005).
  
  
  CONCLUSIONS
  CND is not uncommon among CCS survivors. The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population. Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND.
authors.affiliation: Division of Developmental Pediatrics, Department of Pediatrics.
authors.forename: M Florencia
authors.initials: MF
authors.lastname: Ricci
authors.affiliation: Division of Developmental Pediatrics, Department of Pediatrics, Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Canada; and.
authors.forename: John C
authors.initials: JC
authors.lastname: Andersen
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada.
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.affiliation: Division of Developmental Pediatrics, Department of Pediatrics, Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Canada; and.
authors.forename: Man-Joe
authors.initials: MJ
authors.lastname: Watt
authors.affiliation: School of Public Health, and.
authors.forename: Elham Khodayari
authors.initials: EK
authors.lastname: Moez
authors.affiliation: School of Public Health, and.
authors.forename: Irina A
authors.initials: IA
authors.lastname: Dinu
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Garcia Guerra
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada;
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada;
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
authors.affiliation: Division of Developmental Pediatrics, Department of Pediatrics, Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Canada; and Charlene.Robertson@albertahealthservices.ca.
authors.forename: Charlene M T
authors.initials: CM
authors.lastname: Robertson
mesh_terms: D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology*; D002170:Canada; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004185:Disability Evaluation; D019988:Children with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors