A case control study of neurodevelopmental outcome in infants undergoing cardiac vs non cardiac surgery

  • Ms Karen Walker, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof David Winlaw, The Children's Hospital at Westmead, Sydney., Australia
  • Mr Andrew Cole, The Children's Hospital at Westmead, Sydney., Australia
  • Dr Rober Halliday, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof Andrew Holland, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof Gary Sholler, The Children's Hospital at Westmead, Sydney., Australia
  • Dr Megan Sherwood, The Children's Hospital at Westmead, Australia
  • A/Prof Nadia Badawi, The Children's Hospital at Westmead, Sydney., Australia

    • Introduction
    Improvements in neonatal and infant surgery increasingly relate to quality of outcome rather than mortality. There is a well founded concern that a significant number of neonates and infants with congenital heart disease (CHD) display neurodevelopmental impairment (NDI).

    Causes and promoters of NDI are present at every stage from gestation to peri-procedural care and operation. Many factors and the over all burden of critical illness similarly affect children undergoing major non cardiac surgery such as repair of diaphragmatic hernia.

    Method
    This prospective population based case control study commenced enrolment in 2006. We recruited infants who had undergone cardiac or major non-cardiac surgery in the first 90 days and compared both with normal infants.
    Circulatory arrest was not employed in the cardiac surgery group.
    Developmental outcomes were measured using the Bayley Scales of Infant and Toddler Development Version III. Clinical data, including brain imaging, were also documented.

    Results
    329 case and control infants were assessed at one year of age. See table below.

    Conclusion
    Early results confirm a significant level of NDI in those undergoing cardiac and non cardiac surgery with a higher percentage of the cardiac surgery group being affected. The study highlights the need for i) evaluation of how medical and surgical approaches can be tailored to minimise the impact of both disease and treatment in those with CHD and ii) routine surveillance of these groups to provide early intervention where required.

    Gross Motor Subtest Expressive Language subtest Receptive Language subtest
    (% below average) (% below average) (% below average)
    Cardiac surgery group 49 41 25
    Non cardiac surgery group 34 22 25
    Control infants 15 10 14