Postoperative morbidities with infant cardiac surgery and toddlers' neurodevelopment

Julie Read; Deborah Ridout; Samantha Johnson; Aparna Hoskote; Karen Sheehan; Paul Wellman; Alison Jones; Jo Wray; Katherine Brown

doi:10.1136/archdischild-2021-322756

Postoperative morbidities with infant cardiac surgery and toddlers' neurodevelopment

Arch Dis Child. 2022 Sep 20;107(10):922-928. doi: 10.1136/archdischild-2021-322756.

Authors

Julie Read¹, Deborah Ridout², Samantha Johnson³, Aparna Hoskote⁴, Karen Sheehan⁵, Paul Wellman⁶, Alison Jones⁷, Jo Wray¹, Katherine Brown⁸

Affiliations

¹ Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Trust, London, UK.
² Paediatric Epidemiology Biostatistics, University College London Institute of Child Health, London, UK.
³ Department of Health Sciences, University of Leicester, Leicester, UK.
⁴ Heart and Lung Division, Great Ormond Street Hospital National Institute Health Research Biomedical Research Centre, London, UK.
⁵ Department of Paediatric Cardiology, Bristol Royal Children's Hospital, Bristol, UK.
⁶ Department of Paediatric Intensive Care, Evelina London Children's Hospital, London, UK.
⁷ Department of Paediatric Intensive Care, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
⁸ Heart and Lung Division, Great Ormond Street Hospital National Institute Health Research Biomedical Research Centre, London, UK katherine.brown@gosh.nhs.uk.

PMID: 35793944
DOI: 10.1136/archdischild-2021-322756

Abstract

Objective: To evaluate the relationship between morbidities after infant cardiac surgery and neurodevelopment and behaviour at age 2-3 years.

Design/setting: A prospective cohort follow-up study, in four paediatric cardiac centres. We excluded children with known syndromes. Home-based neurodevelopmental assessments using the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) were undertaken in 81 children and secondary outcome measures of development and behaviour were completed by parents. A further 41 families completed the secondary outcome measures remotely.

Results: Children were grouped as multiple morbidities/extracorporeal life support (ECLS) (n=19), single morbidities (n=36) and no morbidities (n=59). Group comparisons found that children with multiple morbidities/ECLS, compared with no morbidities, had: (a) lower adjusted mean scores for core Bayley-III composites (none reached the level of statistical significance), with mean differences of cognitive -6.1 (95% CI -12.4 to 0.1) p=0.06, language -9.1 (95% CI -18.6 to 0.3) p=0.06 and motor -4.4 (95% CI -12.0 to 3.1) p=25; (b) greater adjusted odds of at least one low or borderline Bayley-III composite result 4.0 (95% CI 1.0 to 16.0) (p=0.05); (c) greater adjusted risk of an abnormal Ages and Stages Questionnaire (ASQ) result 5.3 (95% CI 1.3 to 21.1) (p=0.03) and a borderline ASQ result 4.9 (95% CI 1.0 to 25.0) (p=0.05); and no difference in the risk of an abnormal Strengths and Difficulties Questionnaire result 1.7 (95% CI 0.3 to 10.4) p=0.58. These outcomes were not statistically different between the single morbidity and no morbidity groups.

Conclusions: Children who experience multiple morbidities/ECLS after infant heart surgery are at a greater risk of neurodevelopmental difficulties than their peers who had no complications and should be prioritised for neurodevelopmental follow-up.

Keywords: cardiology; child development; child health services; neurology; paediatrics.