Short-term neurodevelopmental outcomes in neonates with congenital heart disease: the era of newer surgical strategies

Abstract

Objective: The objective of this study was to determine neurodevelopmental outcomes up to 30 months of age in a cohort of neonates requiring surgical intervention without circulatory arrest for congenital heart disease and to correlate these outcomes with characteristics detected prior to hospital discharge.

Design and setting: An observational cohort of surviving neonates who underwent surgical intervention without circulatory arrest for congenital heart disease between 2002 and 2003 was studied at a single tertiary care institution.

Patients: Thirty-five patients were followed from 4 to 6 months of age until 24-30 months of age.

Outcome measures: Neuromotor abnormalities, use of special services, and degree of developmental delay at set intervals between 4 and 30 months of age were retrospectively obtained from clinical reports. The relationship between these outcomes and clinical characteristics prior to hospital discharge was analyzed.

Results: Those with neuromotor abnormalities prior to discharge were likely to have persistent abnormalities in muscle strength, tone, and symmetry until 4-6 months of age, odds ratio 6 (1.3-29). By 24-30 months of age, motor abnormalities or developmental delay occurred in 10 of 20 infants (50%), but were no longer significantly associated with predischarge findings.

Conclusions: Infants undergoing surgical intervention for congenital heart disease are at risk for neurodevelopmental abnormalities, which may not become apparent until months after hospital discharge. Early impairment may also resolve over time. Close developmental follow-up in this high-risk cohort of patients is warranted.

Figure 1. Neurodevelopmental Follow-up

The rate of neuromotor abnormalities slightly decreased between 4–6 months and 24–30 months of age. However, the rate of developmental delay and use of special services increased during this same time period.

Figure 2. Detailed Follow-up Characteristics over Time

(A) Motor abnormalities were fairly consistently divided between abnormalities in muscle strength, tone, and symmetry. (B) Developmental delays were predominantly gross motor delays at 4–6 months of age, but speech and language delays at 24–30 months of age. (C) Physical and occupational therapy were substantially utilized by subjects throughout the follow-up period, and speech therapy utilization increased by 24–30 months of age.

Figure 3. Neuromotor Abnormalities

Neuromotor abnormalities of individual subjects identified prior to hospital discharge showed improvement by 12 months of age. However, new and persistent neuromotor abnormalities were also identified in some subjects after hospital discharge.