Cardiac surgery during infancy associated with cognitive, motor delays

Infants who underwent cardiac surgery within the first 6 months of life demonstrated cognitive and motor delays during early childhood, according to a published literature review.

Researchers from Melbourne, Australia, conducted a systematic review to examine literature from longitudinal studies of cognitive and/or motor outcomes for children who had cardiac surgery during early infancy. They used Medline, the Cumulative Index to Nursing and Allied Health Literature (Cinahl) and Embase to perform electronic searches for the findings of relevant studies that were published from 1998 to 2008.

Sixty-five articles were selected for review, according to the researchers. Eight cohorts provided data on cognitive and/or motor outcomes of infants who had undergone cardiac surgery for congenital heart disease when aged younger than 6 months.

Suzanne H. Snookes, BS, of the Royal Children’s Hospital in Melbourne, and Julia K. Gunn, MBBS,of the University of Melbourne, analyzed the study results and grouped data according to age of follow-up: early development (1 year to younger than 3 years); preschool age (3 years to 5 years); and school age (older than 5 years to 17 years). They also applied weighted analysis to pool the results when appropriate.

All of the studies included the Bayley Scales of Infant Development for children aged younger than 3 years, according to the researchers. They combined outcome data from the Bayley Scales for infants assessed when aged 1 year and reported a weighted mean Mental Development Index of 90.3 (95% CI, 88.9-91.6) and Psychomotor Development Index of 78.1 (95% CI, 76.4-79.7).

The researchers also noted that all but one study included cognitive outcomes within 1 standard deviation of the test mean. Additionally, motor outcomes were usually worse, with five articles reporting motor quotients within 1 SD of expected outcome and six including scores between 1 SD and 2 SDs.

“Despite widespread awareness and concern regarding neurodisability in survivors of surgery for congenital heart disease, this systematic review has identified the absolute need for focused long-term studies to investigate the neurodevelopmental outcome of these infants at high risk,” the researchers wrote.

The researchers also said that the findings, though significant, were limited in the preschool- and school-age groups of children. – by Melissa Foster

Snookes SH. Pediatrics. 2010;125:e818-e827.

These findings have significant implications for long-term survival. Particularly of note was that 97% of children had central nervous system anomalies. It was noted that the portion of terminations for people with anomalies increased throughout the study, from 12.4%-15.5% to 15.6- 21.2%, which was significant.

Given the survival estimates for congenital anomaly groups, decisions made to terminate pregnancies will obviously come into the forefront of discussion. The long term anomaly survival rates, especially with central nervous system abnormalities, makes a case that much more care should be taken with ethical decisions when termination of pregnancy is being considered. These findings are extremely significant in light of the pressures parent and families often feel when an anomaly is identified and should be reassuring to the vast majority of families who continue to carry babies to term in light of the identification of such anomalies.

– Steve Shelov, MD
Chairmen, Pediatrics Department
Maimodes Infants and Children's Hospital
Brooklyn, NY

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