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Neurodevelopmental outcomes not linked to surgical management in children with heart defect
Neurodevelopmental impairment in children who undergo early-stage surgery for single-ventricle heart defects is likely more related to innate patient factors and general medical morbidity than intraoperative management, according to data from the largest multicenter clinical trial of this patient population.
For the Single-Ventricle Reconstruction trial, researchers from 15 hospitals in the NHLBI-funded Pediatric Heart Network randomly assigned infants with hypoplastic left-heart syndrome and related single-ventricle defects who were undergoing the Norwood procedure to modified Blalock-Taussig shunt or right ventricular-to-pulmonary artery shunt. They collected data on height, weight, head circumference, interim medical history and socioeconomic status, and used the psychomotor development index and mental development index to evaluate neurodevelopmental outcomes at 14 months.
Study results showed lower scores in mean psychomotor development index and mental development index vs. normative means (each P<.001). Independent predictors of lower psychomotor development index score included:
- Clinical center (P=.003).
- Birth weight less than 2.5 kg (P=.023).
- Longer Norwood hospitalization (P<.001).
- More complications between Norwood procedure discharge and age 12 months (P<.001).
Similarly, independent risk factors for lower mental development index score were:
- Center (P<.001).
- Birth weight less than 2.5 kg (P=.04).
- More complications after Norwood discharge at 12 months (P<.001).
- Genetic syndrome/anomalies (P=.04).
- Lower maternal education (P=.04).
- Longer mechanical ventilation after the Norwood procedure (P<.001).
Psychomotor development index and mental development index score had no significant relationship to perfusion type, other aspects of vital organ support or cardiac anatomy, according to study results.
“Between Norwood discharge and age 12 months, a greater number of complications were also associated with worse development, a novel finding that highlights ongoing brain vulnerability and opportunities for intervention,” researcher Jane W. Newburger, MD, MPH, of Children’s Hospital Boston, said in a press release.
Disclosure: The researchers report no relevant financial disclosures.