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Neurodevelopmental outcome following open heart surgery in infancy: 6-year follow-up

Published online by Cambridge University Press:  10 July 2014

Bryn Jones ,
Frank Muscara ,
Owen Lloyd ,
Lynne McKinlay  and
Robert Justo
Bryn Jones*
Affiliation:
Department of Cardiology, The Royal Children’s Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
Frank Muscara
Affiliation:
Murdoch Children’s Research Institute, Melbourne, Australia
Owen Lloyd
Affiliation:
Queensland Paediatric Rehabilitation Service, Royal Children’s Hospital, Brisbane, Australia
Lynne McKinlay
Affiliation:
Queensland Paediatric Rehabilitation Service, Royal Children’s Hospital, Brisbane, Australia
Robert Justo
Affiliation:
Queensland Paediatric Cardiac Service, Mater Health Services, Brisbane, Australia
*
Correspondence to: Dr B. Jones, Department of Cardiology, The Royal Children’s Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. Tel:+61 3 93455713; Fax:+61 3 93456001. E-mail: bryn.jones@rch.org.au
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Abstract

Background: Children undergoing open heart surgery are at risk of neurological injury. A cohort of 35 patients, who had undergone cardiac surgery during infancy, had a significant reduction in Bayley Scale of Infant Development scores at a 12-month assessment. This cohort has now reached an appropriate age to reassess developmental progress. Methods: Detailed psychometric testing was conducted on 20 children from the original cohort using the Weschler Preschool and Primary Scale of Intelligence, the Wide Range Assessment of Memory and Learning, and the Wechsler Individual Achievement Test. Parents completed the Connor’s Rating Scale, the Behaviour Rating Scale of Executive Functioning, and the Child Behaviour Checklist. Results: The mean age of the cohort at assessment was 6.6 (standard deviation 0.4) years. Mean scores on all tests of intelligence, memory, academic achievement, and executive function fell within the average range. Of the children, 20–35% were found to have significant difficulties across these areas. Mean scores in the areas of social, emotional, behavioural, and psychological functioning also fell within the average range. Of the children studied, 35% had clinically significant problems in these areas. There was only a weak association between the 12-month scores and the Full-Scale Intelligence Quotient at 6 years. Conclusion: Detailed psychometric testing of these children suggests that they generally function in the average range; however, a significant proportion falls below age expectations in all the areas assessed. This highlights the importance of long-term follow-up with routine developmental screening to allow identification of a subgroup that may benefit from early educational and behavioural intervention.

Keywords

Heart defectscongenitalpaediatric cardiac surgerydevelopmental outcome
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 903 - 910
Copyright
© Cambridge University Press 2014 

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References

1. Mahle, W. Neurologic and cognitive outcomes in children with congenital heart disease. Curr Opin Pediatr 2001; 13: 482–486.CrossRefGoogle ScholarPubMed
2. Hovels-Gurich, H, Seghaye, M, Dabritz, S, et al. Cognitive and motor development in preschool and school age children after neonatal arterial switch operation. J Thor Card Surg 1997; 114: 578–585.Google Scholar
3. Miller, G, Eggli, K, Constant, C, Baylen, B, Myers, J. Postoperative neurological complications after open heart surgery on young infants. Arch Pediatr Adolesc Med 1995; 149: 764–768.CrossRefGoogle ScholarPubMed
4. Fallon, P, Aparicio, JM, Elliott, MJ, Kirkham, FJ. Incidence of neurological complications of surgery for congenital heart disease. Arch Dis Child 1995; 72: 418–422.Google Scholar
5. Justo, RN, Janes, EF, Sargent, PH, Jalali, H, Pohlner, PG. Quality assurance of paediatric cardiac surgery: a prospective 6-year analysis. J Paediatr Child Health 2004; 40: 144–148.Google Scholar
6. Kirkham, F. Recognition and prevention of neurological complications in pediatric cardiac surgery. Pediatr Cardiol 1998; 19: 331–345.Google Scholar
7. Menach, C, du Plessis, A, Wessel, D, Jonas, R, Newburger, J. Current incidence of acute neurological complications after open-heart operations in children. Ann Thorac Surg 2002; 73: 1752–1758.Google Scholar
8. Samango-Sprouse, C, Suddaby, EC. Developmental concerns in children with congenital heart disease. Curr Opin Cardiol 1997; 12: 91–98.Google Scholar
9. Wernovsky, G, Shillingford, A, Gaynor, J. Central nervous system outcomes in children with complex congenital heart disease. Curr Opin Cardiol 2005; 20: 94–99.Google Scholar
10. Bellinger, DC, Wypij, D, Rivkin, MJ, et al. Adolescents with d-transposition of the great arteries corrected with the arterial switch procedure: neuropsychological assessment and structural brain imaging. Circulation 2011; 124: 1361–1369.Google Scholar
11. Robertson, DR, Justo, RN, Burke, CJ, Pohlner, PG, Graham, PL, Colditz, PB. Perioperative predictors of developmental outcome following cardiac surgery in infancy. Cardiol Young 2005; 14: 389–395.Google Scholar
12. Wechsler, D. Wechsler Preschool and Primary School Scale of Intelligence (3rd edn.). Australian Standardised Edition. Pearson PsychCorp, Sydney, Australia, 2002.Google Scholar
13. Sheslow, D, Adams, W. Wide Range Assessment of Memory and Learning Second Edition Administration and Technical Manual, Psychological Assessment Resources, Odessa, FL, 2003.Google Scholar
14. Weschler, D. Wechsler Individual Achievement Test 2nd Edition (WIAT II). The Psychological Corp, London, 2005.Google Scholar
15. Gioia, GA, Isquith, PK, Guy, SC, Kenworthy, L. Behavior Rating Inventory of Executive Function. Psychological Assessment Resources, Odessa, FL, 2000.Google Scholar
16. Achenbach, TM, Rescorla, LA. Manual for the ASEBA School-Age Forms and Profiles. University of Vermont, Research Center for Children, Youth, and Families, Burlington, VT, 2001.Google Scholar
17. Connors, CK. Conners’ Rating Scales – Revised. Multi-Health Systems, New York, 2001.Google Scholar
18. Bellinger, DC, Wypij, D, Kuban, KC, et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 1999; 100: 526–532.Google Scholar
19. Mahle, W. Neurologic and cognitive outcomes in children with congenital heart disease. Curr Opin Pediatr 2001; 13: 482–486.Google Scholar
20. Gaynor, JW, Ittenbach, RF, Gerdes, M, et al. Neurodevelopmental outcomes in preschool survivors of the Fontan procedure. J Thorac Cardiovasc Surg 2014; 147: e1275.CrossRefGoogle ScholarPubMed
21. McGrath, E, Wypij, D, Rappaport, LA, Newburger, JW, Bellinger, DC. Prediction of IQ and achievement at age 8 years from neurodevelopmental status at age 1 year in children with d-transposition of the great arteries. Pediatrics 2004; 114: e572–e576.CrossRefGoogle ScholarPubMed
22. McQuillen, PS, Barkovich, AJ, Hamrick, SE, et al. Temporal and anatomic risk profile of brain injury with neonatal repair of congenital heart defects. Stroke 2007; 38: 736–741.Google Scholar
23. Petit, CJ, Rome, JJ, Wernovsky, G, et al. Preoperative brain injury in transposition of the great arteries is associated with oxygenation and time to surgery, not balloon atrial septostomy. Circulation 2009; 119: 709–716.Google Scholar
24. Fuller, S, Rajagopalan, R, Jarvik, GP, et al. J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. Deep hypothermic circulatory arrest does not impair neurodevelopmental outcome in school-age children after infant cardiac surgery. Ann Thorac Surg 2010; 90: 1985–1994.CrossRefGoogle Scholar
25. Beca, J, Gunn, JK, Coleman, L, et al. New white matter brain injury after infant heart surgery is associated with diagnostic group and the use of circulatory arrest. Circulation 2013; 127: 971–979.Google Scholar
26. Spittle, A, Orton, J, Doyle, L, Boyd, R. Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev 2007: CD005495.Google ScholarPubMed
27. Bouchard, T, McGue, M. Familial studies of intelligence: a review. Science 1981; 212: 1055–1059.Google Scholar
28. Najman, J, Bor, W, Morrison, J, Andersen, M, Williams, G. Child developmental delay and socio-economic disadvantage in Australia: a longitudinal study. Soc Sci Med 1992; 34: 829–835.CrossRefGoogle ScholarPubMed