Two-year neurodevelopmental outcomes of infants undergoing neonatal cardiac surgery for interrupted aortic arch: A descriptive analysis
Received 20 August 2008; received in revised form 17 December 2008; accepted 8 March 2009. published online 24 June 2009.
Objective
This study determined neurodevelopmental outcomes of survivors of neonatal cardiac surgery for interrupted aortic arch through an interprovincial program and explored preoperative, intraoperative, and postoperative outcome predictors.
Methods
Children who underwent neonatal cardiac surgery for interrupted aortic arch at 6 weeks old or younger between 1996 and 2006 had a multidisciplinary neurodevelopmental assessment at 18 to 24 months old (mental and psychomotor developmental indices as mean ± SD and delay [score <70]). Survivor outcomes were compared by univariate and multivariate analyses and compared between children with and without chromosomal abnormality.
Results
Outcomes were available for all 26 survivors (mortality, 3.7%). Mental and psychomotor developmental indices were 75.8 ± 17.1 and 72.3 ± 16.9, respectively, with significantly lower scores for children with chromosomal abnormalities, which accounted for 29% of the variance in developmental indices. For the remaining 17 children without chromosomal abnormalities, mental and psychomotor developmental indices were 82.7 ± 14.5 and 79.1 ± 14.3, respectively, with deep hypothermic circulatory arrest time and Apgar score at 5 minutes contributing 46% of the variance in mental developmental index.
Conclusions
The neurodevelopmental indices of children who have undergone neonatal cardiac surgery for interrupted aortic arch are below normative values; those of children with chromosomal abnormalities are even lower. For children without a chromosomal abnormality, longer deep hypothermic circulatory arrest times and low Apgar scores predict lower mental developmental indices at 18 to 24 months of age.
eDepartment of Pediatrics, University of Calgary, Calgary, Alberta, Canada
fPost of Biostatistician, Research Methods Team, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
gWestern Canadian Complex Pediatric Therapies Follow-up Group (D. Moddemann, Winnipeg, Manitoba, Canada, A. Synnes, Vancouver, British Columbia, Canada, and J. Bodani, Regina, Saskatchewan, Canada)
Address for reprints: Charlene M. T. Robertson, MD, Room 242, GlenEast, Glenrose Rehabilitation Hospital, 10230 111 Ave, Edmonton, Alberta, Canada, T5G 0B7.
Supported initially by the Glenrose Rehabilitation Hospital Research Trust Fund, with ongoing funding from the Registry and Follow-up of Complex Pediatric Therapies Project, Alberta Health and Wellness.
ABSTRACT