Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-13T02:26:32.656Z Has data issue: false hasContentIssue false
  • English
  • Français

Perioperative predictors of developmental outcome following cardiac surgery in infancy

Published online by Cambridge University Press:  21 January 2005

Daphene R. Robertson ,
Robert N. Justo ,
Chris J. Burke ,
Peter G. Pohlner ,
Petra L. Graham  and
Paul B. Colditz
Daphene R. Robertson
Affiliation:
Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
Robert N. Justo
Affiliation:
Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
Chris J. Burke
Affiliation:
Department of Neurology, Royal Children's Hospital, Brisbane, Australia
Peter G. Pohlner
Affiliation:
Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
Petra L. Graham
Affiliation:
School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia
Paul B. Colditz
Affiliation:
Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
Get access Rights & Permissions [Opens in a new window]

Abstract

At 1 year we assessed the neurodevelopmental outcomes in infants undergoing cardiac surgery, seeking to explore the predictive value of perioperative markers of cerebral injury. We prospectively enroled 47 neurodevelopmentally normal infants prior to planned cardiac surgery. Postoperative monitoring consisted of 10-channel video synchronised, continuous electroencephalography from 6 to 30 h, Doppler assessment of cerebral blood flow in the anterior cerebral artery at 1, 2, 3 and 5 h, and measurement of serum S-100B at 0 and 24 h. Neurodevelopmental assessments were performed using the second edition of the Bayley Scale of Infant Development. Follow-up at 1 year was available on 35 infants. The mean age of these patients at surgery had been 57 ± 15 days. We observed clinical seizures in 1 patient, with 3 other patients having electroencephalographic abnormalities. At follow-up of 1 year, neurodevelopmental scores were lower than preoperative scores, with mean mental scores changing from 103 ± 5 to 94 ± 13 (p = 0.001), and mean motor scores changing from 99 ± 8 to 89 ± 20 (p = 0.004). No association was found between electroencephalographic abnormalities, reduced cerebral blood flow, or elevation of serum S-100B levels and impaired neurodevelopmental outcome at 1 year. Infants with electroencephalographic abnormalities had elevation of the levels of S-100B in the serum (p = 0.02). At 1 year of follow-up, infants undergoing cardiac surgery demonstrated a reduction in the scores achieved using the second edition of the Bayley Scale of Infant Development. They require ongoing assessment of their progress. Electroencephalographic abnormalities, cerebral blood flow, or levels of S-100B in the serum were not useful perioperative markers for predicting a poor neurodevelopmental outcome in the clinical setting.

Keywords

Paediatric cardiac surgerydevelopmental outcome
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 4 , August 2004 , pp. 389 - 395
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Menache CC, du Plessis AJ, Wessel DL, Jonas RA, Newberger JW. Current incidence of acute neurological complications after open-heart operations in children. Ann Thorac Surg 2002; 73: 1752–1758.Google Scholar
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: 140–148.Google Scholar
Kirkham FJ. Recognition and prevention of neurological complications in pediatric cardiac surgery. Pediatr Cardiol 1998; 19: 331–345.Google Scholar
Fallon P, Aparicio JM, Elliot MJ, Kirkham FJ. Incidence of neurological complications of surgery for congenital heart disease. Arch Dis Child 1995; 72: 418–422.Google Scholar
Helmers SL, Wypij D, Constantinou JE, Newberger JW, Hickey PR, Carrazana EJ, Barlow JK, Kuban KC, Holmes GL. Perioperative electroencephalographic seizures in infants undergoing repair of complex congenital cardiac defects. Electroencephalogr Clinical Neurophysiol 1997; 102: 27–36.Google Scholar
Newberger JW, Jonas RA, Wernovsky G, Wypij D, Hickey PR, Kuban KC, Farrell DM, Holmes GL, Helmers SL, Constantinou J, Carrazanna E, Barlow JK, Walsh AZ, Lucius KC, Share JC, Wessel DL, Hanley FL, Mayer JE, Castaneda AR, Ware JH. A comparison of the perioperative neurological effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 1993; 329: 1057–1064.Google Scholar
Ment LR, Vohr H, Allan W, Katz KH, Schneider KC, Westerveld M, Duncan CC, Makuch RW. Change in cognitive function over time in very low-birth-weight infants. JAMA 2003; 289: 705–711.Google Scholar
Majnemer A. Benefits of early intervention for children with developmental disabilities. Semin Pediatr Neurol 1998; 5: 62–69.Google Scholar
Dittrich H, Buhrer C, Grimmer I, Dittrich S, Abdul-Khaliq H, Lange PE. Neurodevelopment at 1 year of age in infants with congenital heart disease. Heart 2003; 89: 436–441.Google Scholar
O'Hare B, Bissonnette B, Bohn D, Cox P, Williams W. Persistent low cerebral blood flow velocity following profound hypothermic circulatory arrest in infants. Can J Anaesth 1995; 42: 964–971.Google Scholar
Lindberg L, Olsson A, Anderson K, Jogi P. Serum S-100 protein levels after pediatric cardiac operations: a possible new marker for postperfusion cerebral injury. J Thorac Cardiovasc Surg 1998; 116: 281–285.Google Scholar
Shewmon DA. What is a neonatal seizure? Problems in definition and quantification for investigative purposes. J Clin Neurophysiol 1990; 7: 315–368.Google Scholar
Monod N, Pajot N, Guidasci S. The neonatal EEG: statistical studies and prognostic value in full-term and pre-term babies. Electroencephalogr Clin Neurophysiol 1972; 32: 529–544.Google Scholar
Trivedi UH, Patel RL, Turtle MRJ, Venn GE, Chambers DJ. Relative changes in cerebral blood flow during cardiac operations using Xenon-133 clearance versus transcranial Doppler sonography. Ann Thor Surg 1997; 63: 167–174.Google Scholar
Jonsson H, Johnsson P, Alling C, Westaby S, Blomquist S. Significance of serum S100 release after coronary artery bypass grafting. Ann Thorac Surg 1998; 65: 1639–1644.Google Scholar
Bayley N. Bayley Scales of Infant Development, 2nd edn. The Psychological Corporation. Harcourt Brace and Company, San Antonio, 1993.
Bellinger DC. Cardiac surgery and the brain: differences between adult and paediatric studies. Heart 2003; 89: 365–366.Google Scholar
Limperopoulos C, Majnemer OT, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurologic status of newborns with congenital heart defects before open heart surgery. Pediatrics 1999; 103: 402–408.Google Scholar
Hovels-Gurich HH, Seghaye MC, Schnitker R, Wiesner M, Huber W, Minkenberg R, Kotlarek F, Messmer BJ, von Bernuth G. Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch. J Thorac Cardiovasc Surg 2002; 124: 448–458.Google Scholar
Hovels-Gurich HH, Seghayeb MC, Sigler M, Kotlarekn F, Bartl A, Neuser J, Minkenberg R, Messmer B, von Bernuth G. Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch. Ann Thorac Surg 2001; 71: 881–888.Google Scholar
Sharma R, Choudhary SK, Mohan MR, Padma MV, Jain S, Bhardwaj M, Bhan A, Kiran U, Saxena N, Venugopal P. Neurological evaluation and intelligence testing in the child with operated congenital heart disease. Ann Thorac Surg 2000; 70: 575–581.Google Scholar
Bellinger DC, Wypij D, Kuban KC, Rappaport LA, Hickey PR, Wernovsky G, Jonas RA, Newberger JW. Developmental and neurological status of children 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 1999; 100: 526–532.Google Scholar
Rappaport LA, Wypij D, Bellinger DC, Helmers SL, Holmes GL, Barnes PD, Wernovsky G, Kuban KC, Jonas RA, Newberger JW. Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Circulation 1998; 97: 773–779.Google Scholar
Bellinger DC, Rappaport LA, Wypij D, Wernovsky G, Newberger JN. Patterns of developmental dysfunction after surgery during infancy to correct transposition of the great arteries. J Dev Behav Pediatr 1997; 18: 75–83.Google Scholar
Bellinger DC, Wernovsky G, Rappaport LA, Mayer JE, Castaneda AR, Farrell DM, Wessel DM, Lang P, Hickey PR, Jonas RA, Newberger JW. Cognitive development of children following early repair of transposition of the great arteries using deep hypothermic circulatory arrest. Pediatrics 1991; 87: 701–707.Google Scholar
Hack M, Wright LL, Shankaran S. Very-low-birth-weight outcomes of the National Institute of Child Health and Human Neonatal Developmental Network, November 1989 to October 1990. Am J Obstet Gynecol 1995; 172: 457–464.Google Scholar
O'Shea TM, Goldstein DJ. Follow-up data: their use in evidence-based decision making. Clin Perinatal 2003; 30: 217–250.Google Scholar
Kilminster S, Treasure T, McMillan T, Holt DW. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke 1999; 30: 1869–1874.Google Scholar
Shaaban M, Harmer M, Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anaesth 2000; 85: 287–298.Google Scholar
Koide M, Kunii Y, Moriki N, Ayusawa Y, Sakai A. Clinical significance of serum S-100B protein level after paediatric cardiac surgery. Jpn J Thorac Cardiovasc Surg 2002; 50: 280–283.Google Scholar
Camci E, Tugrul M, Korkut K, Tireli E. Blood S-100 protein concentration in children undergoing cardiac surgery. J Cardiothoracic Vasc Anaesth 2001; 15: 29–34.Google Scholar
Jensen E, Sandstrom K, Andreasson S, Nilsson K, Berggren H, Larsson LE. Increased levels of S-100 protein after cardiac surgery with cardiopulmonary bypass and general surgery in children. Paediatr Anaesth 2000; 10: 297–302.Google Scholar
Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 1997; 23: 201–207.Google Scholar
Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24: 743–752.Google Scholar