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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
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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

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