Effect of congenital heart disease on 4-year neurodevelopment within multiple-gestation births.
We sought to assess the effect of congenital heart disease requiring infant surgery with cardiopulmonary bypass on neurodevelopmental outcomes and growth at 4 years of age, while matching for gestational age, socioeconomic status, maternal gestational conditions, home environment, and parental intelligence by studying multiple-gestation births.



We performed within-family comparison of 14 multiple-gestation births in which 1 child had congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age. Between 4 and 5 years of age, a comprehensive neurodevelopmental assessment was performed. Paired comparisons were conducted between siblings with and without heart defects using a series of nonparametric tests.



On average, the children qualified as late preterm (mean gestational age 35.4 ± 2.6 weeks). At an average age of 4.8 ± 0.1 years, children with congenital heart disease weighed less than their siblings (median weight for age z score -0.4 vs 0.1, P = .02) and had worse performance for cognition (median full-scale IQ 99 vs 109, P = .02) and fine motor skills (median Wide Range Assessment of Visual Motor Ability, Fine Motor score 94.5 vs 107.5, P < .01).



After controlling for socioeconomic status, home environment, parental intelligence, and gestational factors by using multiple-gestation births, congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age is associated with lower weight, cognitive abilities and fine motor skills at 4 years of age.
Division of Cardiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Wash. Electronic address: amy.schultz@seattlechildrens.org.
Amy H
AH
Schultz
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Richard F
RF
Ittenbach
Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Marsha
M
Gerdes
Departments of Medicine (Division of Medical Genetics) and Genome Sciences, University of Washington, Seattle, Wash.
Gail P
GP
Jarvik
Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Gil
G
Wernovsky
Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Judy
J
Bernbaum
Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Cynthia
C
Solot
Division of Neurology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Robert R
RR
Clancy
Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Susan C
SC
Nicolson
Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Thomas L
TL
Spray
Division of Genetics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Donna
D
McDonald-McGinn
Division of Genetics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
Elaine
E
Zackai
Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.
J William
JW
Gaynor
D002315:Cardiopulmonary Bypass; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009099:Multiple Birth Offspring; D065886:Neurodevelopmental Disorders / Q000209:etiology*; D013997:Time Factors
cardiac surgery; complications; congenital; etiology; heart defects; neurodevelopmental disorders; triplets; twins