Performance of 2-year-old children after early surgery for congenital heart disease on the Bayley Scales of Infant and Toddler Development, Third Edition. Prediction of preschool functional abilities after early complex cardiac surgery. Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy Overestimating Neurodevelopment Using the Bayley-III After Early Complex Cardiac Surgery Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. A new look at outcomes of infants with congenital heart disease. Patterns of Developmental Dysfunction After Surgery During Infancy to Correct Transposition of the Great Arteries Neurodevelopmental outcome following exposure to sedative and analgesic drugs for complex cardiac surgery in infancy. Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age. Apolipoprotein E genotype and neurodevelopmental sequelae of infant cardiac surgery. Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5-Year Neurocognitive Outcomes Follow-up Outcomes at 1 and 2 Years of Infants Born Less Than 32 Weeks After Newborn Individualized Developmental Care and Assessment Program Neurotoxicity of sedative and analgesia drugs in young infants with congenital heart disease: 4-year follow-up. Neurodevelopment in children with hypoplastic left heart syndrome. Relationship between Social-Emotional and Neurodevelopment of 2-Year-Old Children with Congenital Heart Disease. Prediction of IQ and Achievement at Age 8 Years From Neurodevelopmental Status at Age 1 Year in Children With D-Transposition of the Great Arteries Length of stay after infant heart surgery is related to cognitive outcome at age 8 years.
BACKGROUND Previous research on developmental outcomes of infants with congenital heart disease ( CHD ) has shown delays in both cognitive and motor skills . AIMS To describe outcomes on the Bayley Scales of Infant and Toddler Development , 3rd edition ( Bayley-III ) for infants with CHD and to compare those findings to published results for similar sample s of infants assessed on the 2nd edition of the Bayley Scales ( BSID-II ) . STUDY DESIGN Prospect i ve cohort . PARTICIPANTS AND OUTCOME MEASURES Of 50 infants with CHD who participated in this longitudinal study ( 2006 - 2008 ) at the Royal Children 's Hospital in Melbourne , Australia , 47 were assessed on the Bayley-III ( median age=24.5 months ) ,  administered by a psychologist or neonatologist . Although neither assessor was blind to the CHD diagnosis , they were unaware of results of previous developmental assessment s conducted in this longitudinal study . RESULTS For the Bayley-III cognitive composite score , 17.0 % of infants showed mild delays ( 1 - 2 SD below the mean ) , 2.1 % had moderate delays ( 2 - 3 SD below the mean ) , and none had severe delays ( greater than 3 SD below the mean ) . Motor composite scores showed mild delays in 10.9 % of infants and moderate delays in 2.2 % ; none had severe motor delays . These findings differ from study results using the BSID-II in similar infants . CONCLUSIONS The Bayley-III may underestimate developmental delay in 2-year-old children with CHD when compared to results of similar children tested at 12 - 36 months of age on the BSID-II BACKGROUND It is important to identify early predictors of functional limitations in children after congenital heart surgery to optimise their independence as they prepare for school . The purpose of this study is to determine potentially modifiable predictor variables of functional abilities in pre-school children who underwent complex cardiac surgery at 6 weeks of age or earlier . METHODS This prospect i ve inception cohort study comprised a sample of 165 survivors ( 63 % boys ) who had complex cardiac surgery ( 75 % biventricular repairs ) at Stollery Children 's Hospital , Edmonton , Alberta . We excluded children with chromosomal abnormalities . When children were 4 - 5 years of age , the parents completed the Adaptive Behavioral Assessment System II . Regression analysis was used to assess the association between multiple risk factors and each of the four continuous composite scores . RESULTS The mean scores for the practical domain and general adaptive composite score of the Adaptive Behavioural Assessment System were lower than the conceptual and social domains , with 13.3 % of the children having a delay in the practical domain . There was a significant association between the general adaptive ( p=0.003 ; 0.012 ) , conceptual ( p=0.0004 ; 0.042 ) , social ( p=0.0007 ; 0.028 ) , and the practical ( p=0.046 ; 0.003 ) domain composite scores with the mother 's education and preoperative plasma lactate , respectively . CONCLUSION Maternal education may be a marker for the social context of children , and warrants societal attention to improve functional outcomes . Preoperative lactate as a potentially modifiable variable may warrant increased attention to early diagnosis and aggressive resuscitation of young infants with congenital heart disease Objective Historical cohort studies have reported adverse neurodevelopment following cardiac surgery during early infancy . Advances in surgical techniques and perioperative care have coincided with updating of neurodevelopmental assessment tools . We aim ed to determine perioperative risk factors for impaired neurodevelopment at 2 years following surgery for congenital heart disease ( CHD ) in early infancy . Design and patients We undertook a prospect i ve longitudinal study of 153 full-term infants undergoing surgery for CHD before 2 months of age . Infants were excluded if they had a genetic syndrome associated with neurodevelopmental impairment . Outcome measures Predefined perioperative parameters were recorded and infants were classified according to cardiac anatomy . At 2 years , survivors were assessed using the Bayley Scales of Infant Development-III . Results At 2 years , 130 children ( 98 % of survivors ) were assessed . Mean cognitive , language and motor scores were 93.4±13.6 , 93.6±16.1 and 96.8±12.5 respectively ( 100±15 norm ) . Twenty ( 13 % ) died and 12 ( 9 % ) survivors had severe impairment ( score < 70 ) , mostly language ( 8 % ) . The lowest scores were in infants born with single ventricle physiology with obstruction to the pulmonary circulation who required a neonatal systemic-to-pulmonary artery shunt . Additional risk factors for impairment included reduced gestational age , postoperative elevation of lactate or S100B and repeat cardiac surgery . Conclusions In the modern era of infant cardiac surgery and perioperative care , children continue to demonstrate neurodevelopmental delays . The use of up date d assessment tools has revealed early language dysfunction and relative sparing of motor function . Ongoing follow-up is critical in this high-risk population BACKGROUND : The newest measure of neurodevelopmental outcomes , the Bayley Scales of Infant and Toddler Development , 3rd Edition ( Bayley-III ) , gives higher-than-expected scores for preterm infants ; results after cardiac surgery are unknown . OBJECTIVES : The goal of this study was to report Bayley-III scores after cardiac surgery and compare the results with those of the Bayley Scales of Infant Development , 2nd Edition ( BSID-II ) on a subset of the same children . METHODS : In this prospect i ve , inception cohort , neurodevelopmental outcome study after complex cardiac surgery in infants from 2004 to 2007 , the Bayley-III was given to 110 survivors ( 68 % boys ) at a mean age of 21 months ( SD : 4 months ) . Analysis of variance was used to compare intergroup differences . Results for both test editions on the same 25 children were compared by using paired- sample s statistics . RESULTS : Mean ( SD ) Bayley-III mean composite scores ( CSs ) for 110 children were as follows : cognitive , 95.9 ( 14.1 ) ; language , 90.8 ( 18.1 ) ; and motor , 93.7 ( 14.2 ) , differentiating selected cardiac surgery groups . The average difference in mean CSs was 7.4 points higher than BSID-II scores for a previous cohort from this site and 7.2 points higher than a systematic review report . Direct comparison of BSID-II and Bayley-III revealed an average difference in mean CSs of 6.1 points , similar to normative results . Mean cognitive CSs increased by 10.0 ( P < .001 ) , language by 1.4 ( P = .526 ) , and motor by 6.9 points ( P = .009 ) . CONCLUSIONS : Research ers should be careful attributing higher Bayley-III scores to changes in acute care . At-risk children who previously qualified for early developmental intervention may no longer do so . School-age longitudinal studies are needed to determine the accuracy of early developmental estimates using the Bayley-III BACKGROUND Deep hypothermia with either total circulatory arrest or low-flow cardiopulmonary bypass is used to support vital organs during heart surgery in infants . We compared the developmental and neurologic sequelae of these two strategies one year after surgery . METHODS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a method of support consisting predominantly of circulatory arrest or a method consisting predominantly of low-flow bypass . Developmental and neurologic evaluations and magnetic resonance imaging ( MRI ) were performed at one year of age . RESULTS Of the 171 patients enrolled in the study , 155 were evaluated . After adjustment for the presence or absence of a ventricular septal defect , the infants assigned to circulatory arrest , as compared with those assigned to low-flow bypass , had a lower mean score on the Psychomotor Development Index of the Bayley Scales of Infant Development ( a 6.5-point deficit , P = 0.01 ) and a higher proportion had scores < or = 80 ( i.e. , 2 SD or more below the population mean ) ( 27 percent vs. 12 percent , P = 0.02 ) . The score on the Psychomotor Development Index was inversely related to the duration of circulatory arrest ( P = 0.02 ) . The risk of neurologic abnormalities increased with the duration of circulatory arrest ( P = 0.04 ) . The method of support was not associated with the prevalence of abnormalities on MRI scans of the brain , scores on the Mental Development Index of the Bayley Scale , or scores on a test of visual-recognition memory . Perioperative electroencephalographic seizure activity was associated with lower scores on the Psychomotor Development Index ( P = 0.002 ) and an increased likelihood of abnormalities on MRI scans of the brain ( P < 0.001 ) . CONCLUSIONS Heart surgery performed with circulatory arrest as the predominant support strategy is associated with a higher risk of delayed motor development and neurologic abnormalities at the age of one year than is surgery with low-flow bypass as the predominant support strategy This article provides an overview of a longitudinal study on a cohort of 131 newborns and young infants with congenital heart defects who required open heart surgery .  The rationale for the study design is provided as well as a summary of the procedures used to evaluate these children prior to surgery , at discharge after surgery , 12 - 18 months later , and at 5 years of age . Results demonstrate that a substantial proportion of these infants had neurologic and developmental abnormalities prior to surgical repair . Developmental delays were common in children with both cyanotic and acyanotic heart defects , and these deficits persisted to school entry . A number of medical , surgical , demographic and environmental factors were significantly associated with developmental outcomes suggesting a multifactorial etiology to brain injury . Limited educational and rehabilitation re sources for this cohort at early school age suggests that service needs may need to be more carefully planned for this high-risk population . Lessons learnt from this prospect i ve study are highlighted as well as future directions for research and clinical practice A r and omized clinical trial was conducted to compare the early development of children with d-transposition of the great arteries ( N=171 ) repaired by an arterial switch operation that used either  predominantly total circulatory arrest or predominantly continuous low-flow cardiopulmonary bypass . The children assigned to the circulatory arrest group scored lower than those assigned to low-flow bypass on the Bayley Scales of Infant Development at 1 year of age . Responses to parental question naires completed when the children were 2.5 years old indicated that the children in the circulatory arrest group , especially those with a ventricular septal defect , also manifested poorer expressive language and were considered to display more internalizing and externalizing problem behaviors . The use of circulatory arrest to protect vital organs during open heart surgery might place children at increased risk of early developmental difficulties , especially in the domains of motor and language function OBJECTIVES / AIM To determine whether sedation/analgesia drugs used before , during , and after infant cardiac surgery are associated with neurodevelopmental outcome . BACKGROUND Animal models suggest detrimental effects of anesthetic drugs on the developing brain . Whether these results can be extrapolated to human neonates is unclear . METHODS / MATERIAL S This is a prospect i ve follow-up project conducted in Western Canada . In all infants ≤6 weeks of age having surgery for congenital heart disease between April 2003 and December 2006 , demographic and perioperative variables were collected prospect ively .  Sedation/analgesia variables were collected retrospectively . For each drug class ( inhalationals , opioids , benzodiazepines , ketamine , and chloral hydrate ) , we calculated the cumulative dose received during hospitalization , average dose received per day , and cumulative number of days the patient received the drug . The outcomes at 18 - 24 months were as follows : General Adaptive Composite and motor scaled scores of the Adaptive Behavior Assessment System , significant mental , motor , and vocabulary delay . Multivariable logistic and linear regression was used to analyze the data . RESULTS One hundred and thirty-five neonates underwent open heart surgery ; 19 died , 16 had chromosomal abnormality , and five were lost to follow up , leaving 95 survivors for analysis . Multiple linear regression analysis found no evidence of an association between sedation/analgesia variables and ABAS-GAC score or motor scale score . Multiple logistic regression analysis found no evidence of an association between sedation/analgesia variables and significant mental , motor , or vocabulary delay . CONCLUSION We found no evidence of an association between dose and duration of sedation/analgesia drugs during the operative and perioperative period and adverse neurodevelopmental outcomes BACKGROUND Early identification of infants with CHD at heightened risk of developmental delays can inform surveillance priorities . This study investigated pre-operative and post-operative neuromotor performance in infants undergoing open-heart surgery , and their developmental status at 6 months of age , to identify risk factors and inform care pathways . METHODS Infants undergoing open-heart surgery before 4 months of age were recruited into a prospect i ve cohort study . Neuromotor performance was assessed pre-operatively and post-operatively using the  Test of Infant Motor Performance and Prechtl 's Assessment of General Movements .  Development was assessed at 6 months of age using the Ages and Stages Question naire third edition . Pre-operative and post-operative General Movements performance was compared using McNemar 's test and test of infant motor performance z-scores using Wilcoxon 's signed rank test . Risk factors for delayed development at 6 months were explored using logistic regression . RESULTS Sixty infants were included in this study . In the 23 ( 38 % ) infants . A total of 60 infants were recruited . In the 23 ( 38 % ) infants assessed pre-operatively , there was no significant difference between pre- and post-operative performance on the GMs ( p=0.63 ) or TIMP ( p=0.28 ) . At discharge , 15 ( 26 % ) infants presented with abnormal GMs , and the median TIMP z-score was -0.93 ( IQR : -1.4 to -0.69 ) . At 6 months , 28 ( 52.8 % ) infants presented with gross motor delay on the ASQ-3 , significantly negatively associated with gestational age ( p=0.03 ) , length of hospital stay ( p=0.04 ) and discharge TIMP score ( p=0.01 ) . CONCLUSIONS Post-operative assessment using the GMs and TIMP may be useful to identify infants requiring individualised care and targeted developmental follow-up . Long-term developmental surveillance beyond 6 months of age is recommended BACKGROUND There has been increasing recognition of adverse neurodevelopmental sequelae in some children after repair of congenital heart defects . Even among children with the same cardiac defect , significant interindividual variation exists in developmental outcome . Polymorphisms of apolipoprotein E have been identified as a risk factor for worse neurologic recovery after central nervous system injury . METHODS A single-institution prospect i ve study of patients < or=6 months of age undergoing cardiopulmonary bypass for repair of congenital heart defects was undertaken to evaluate the association between apolipoprotein E genotype and postoperative neurodevelopmental dysfunction . Developmental outcomes were evaluated at 1 year of age by using the Bayley Scales of Infant Development . RESULTS One-year evaluation was performed in 244 patients . After adjustment for preoperative and postoperative covariates-including gestational age , age at operation , sex , race , socioeconomic status , cardiac defect , and use of deep hypothermic circulatory arrest-the apolipoprotein E epsilon2 allele was associated with a worse neurologic outcome as assessed by the Psychomotor Developmental Index of the Bayley Scales of Infant Development ( P = .036 ) . Patients with the apolipoprotein E epsilon2 allele had approximately a 7-point decrease in the Psychomotor Developmental Index . CONCLUSIONS Apolipoprotein E epsilon2 allele carriers had significantly lower Psychomotor Development Index scores at 1 year of age after infant cardiac surgery . The effect was independent of ethnicity , socioeconomic status , cardiac defect , and use of deep hypothermic circulatory arrest . An effect of the apolipoprotein E epsilon4 allele was not detected . Genetic polymorphisms that decrease neuroresiliency and impair neuronal repair after central nervous system injury are important risk factors for neurodevelopmental dysfunction after infant cardiac surgery Background We aim ed to determine whether sepsis is associated with neurocognitive outcomes 4.5 years after congenital heart disease surgery in early infancy . Methods and Results A secondary analysis from a prospect i ve inception cohort included all children having congenital heart disease surgery done at ≤6 weeks of age with cardiopulmonary bypass at the Western Canadian referral center from 1996 to 2009 . Follow-up at the referral center determined the primary outcomes at 4.5 years with full-scale , performance , and verbal intelligence quotients on the Wechsler Preschool and Primary Scale of Intelligence . Perioperative variables were collected prospect ively , and confirmation of blood culture – positive sepsis was done retrospectively . Multiple linear regression models for neurocognitive outcomes and multiple Cox proportional hazards regression for mortality were determined . Sepsis occurred in 97 of 502 patients ( 19 % ) overall and in 76 of 396 survivors ( 19 % ) with 4.5-year follow-up . By 4.5 years , there were 91 ( 18 % ) deaths , and 396 of 411 survivors ( 96 % ) had follow-up completed . Extracorporeal membrane oxygenation was associated with worse scores on all neurocognitive outcomes on multivariable regression ; the association between extracorporeal membrane oxygenation and full-scale intelligence quotient had a regression coefficient of −13.6 ( 95 % CI −21.3 to −5.9 ; P = 0.001 ) . Sepsis perioperatively was associated with performance and verbal intelligence quotients , with a trend for full-scale intelligence quotient ( P = 0.058 ) on multivariable regression . The regression coefficient for sepsis was strongest for performance intelligence quotient ( −5.31 ; 95 % CI −9.84 to −0.78 ; P = 0.022 ) . Sepsis was not but extracorporeal membrane oxygenation was associated with mortality by 4.5 years . Conclusions Perioperative sepsis and extracorporeal membrane oxygenation were associated with adverse neurocognitive outcomes on multivariable regression . Quality improvement to prevent sepsis has the potential to improve long-term neurocognitive outcomes in infants after surgery for congenital heart disease OBJECTIVE . This was a r and omized , controlled trial to investigate the effect of Newborn Individualized Developmental Care and Assessment Program on growth , cognitive , psychomotor , and neuromotor development at 1 and 2 years in infants born at < 32 weeks ’ gestational age . METHODS . Infants were r and omly assigned within 48 hours of birth to the  newborn individualized developmental care and assessment program group ( intervention ) or basic developmental care group ( control group [ ie , incubator covers and nests ] ) . At 1 and 2 years ’ corrected age , growth was measured and st and ardized neurologic examinations were administered . Mental and psychomotor development was assessed by using the Dutch version of the Bayley Scales of Infant Development II . Neurologic outcome , Psychomotor Developmental Index , and Mental Developmental Index scores were combined a total outcome measure . RESULTS . One hundred sixty-eight infants were recruited ( intervention : 84 ; control : 84 ) . Four infants ( newborn intervention : 3 ; control : 1 ) were excluded because they were admitted less than or died within the first 5 days , leaving a total of 164 infants who met inclusion criteria .  In-hospital mortality was 8 of 81 in the intervention group and 3 of 83 in the control group . At 1 year of age 148 children ( intervention : 70 ; control : 78 ) and at 2 years of age 146 children ( intervention : 68 ; control : 78 ) were assessed . There was no significant difference in growth at 1 and 2 years of age . There was no significant difference found in neurologic outcomes or mental and psychomotor development at 1 and 2 years of age . When neurologic outcome , Mental Developmental Index and Psychomotor Developmental Index scores were combined , there still remained no significant difference . CONCLUSIONS . Newborn individualized developmental care and assessment program developmental care showed no effect on growth or neurologic , mental , or psychomotor development at 1 and 2 years of age in infants born at < 32 weeks . Duration of the intervention was not associated with neurologic and developmental outcome OBJECTIVES / AIM To determine whether sedation/analgesia drugs used before , during , and after infant cardiac surgery are associated with neurocognitive and functional outcomes . BACKGROUND Some animal models suggest neurotoxic effects of anesthetic drugs on the developing brain ; however , potential human effects are unknown . Whether these results can be extrapolated to humans is unknown . METHODS / MATERIAL S Prospect i ve follow-up project of all infants ≤6 weeks old having surgery for congenital heart disease between 04/03 and 12/06 . Demographic , perioperative , and sedation/analgesia variables were collected . Outcomes at kindergarten age were Wechsler Preschool and Primary Scale of Intelligence-III , Beery-Buktenica Developmental Test of Visual Motor Integration ( VMI-V ) , and General Adaptive Composite ( GAC ) of the Adaptive Behavior Assessment System-II .  Multivariable linear regression was used to identify predictor variables . RESULTS From 135 infants who underwent heart surgery , 19 died , 17 were excluded , 8 were lost to follow-up , leaving 91 children for analysis . Multiple linear regression found days on chloral hydrate [ 3.5 ( 3.7 ) days ] was associated with lower performance intelligence quotient ( PIQ ) ( Effect size -1.03 ; 95 % CI -1.96 , -0.10 ; P = 0.03 ) , and cumulative dose [ 54.2 ( 60.3 ) mg·kg(-1 ) ] of benzodiazepines was associated with lower VMI scores ( Effect size -0.07 ; 95 % CI -0.12 , -0.01 ; P = 0.026 ) . No other associations were found between sedation/analgesia variables and full-scale IQ , PIQ , Verbal IQ , VMI , or GAC . CONCLUSION Assessment of this cohort at kindergarten age found a small statistically significant association between days on chloral hydrate and PIQ , and benzodiazepine cumulative dose and lower VMI . No other association between sedation/analgesia drugs and outcomes was found OBJECTIVE To assess neurodevelopment in children with hypoplastic left heart syndrome ( HLHS ) or other types of functionally single ventricle ( univentricular heart , UVH ) and to estimate the effect of possible clinical predictors on outcome . STUDY DESIGN A total of 22 patients with HLHS and 14 with UVH , surviving after palliative surgery performed in the same center , and 42 healthy control subjects were examined at a median age of 30.2 months neurologically and according to the Bayley Scales of Infant Development  in a population based prospect i ve neurodevelopmental follow-up study . RESULTS The mean Mental Developmental Index was significantly lower ( 89.9 ) in patients with HLHS than in control subjects ( 105.5 , P<.001 ) , whereas there was no difference between patients with UVH ( 98.5 ) and control subjects . The mean Psychomotor Developmental Index in patients with HLHS ( 80.7 , P<.001 ) as well as in those with UVH ( 94.5 , P=.016 ) was significantly inferior to that in control subjects ( 105.3 ) . CONCLUSIONS In patients with HLHS , mean Mental Developmental Index lags behind control subjects . Psychomotor Developmental Index is impaired in patients with both HLHS and UVH . Routine neurodevelopmental follow-up is recommended for this seriously ill patient group OBJECTIVE The purpose of this study was to describe social-emotional outcomes and the relationship with neurodevelopmental outcomes in a cohort of 2-year-old children who underwent surgery for congenital heart disease ( CHD ) in infancy , and explore the relationship between the outcomes and parental and surgical factors . DESIGN A two-center prospect i ve cross-sectional cohort study . PATIENTS A cohort of 105 2-year-olds who underwent surgery in infancy for severe CHD MEASURES : Social-emotional and neurodevelopment was evaluated with the  Infant and Toddler Social and Emotional Assessment tool ( ITSEA ) , and the Bayley Scales of Infant Toddler Development , Third Edition . RESULTS Neurodevelopment was delayed in the CHD cohort with significantly worse results compared to published Australian-based norms in all domains ( P < .001 ) and in the Cognitive ( P < .001 ) and Language ( P < .001 ) domains with respect to the reported American norms . Social-emotional outcome was similar to Australian norms in all domains but better than the American based norms in the Internalizing domain ( P < .05 ) . Higher maternal education was associated to better neurodevelopmental outcome in all domains and better scores in the internalizing and externalizing domains of the ITSEA . There was a moderate correlation ( r = 0.43 , P < .001 ) between Language and social-emotional competence . Motor development was influenced by the need for a significant cardiac reoperation . CONCLUSIONS The influences of social factors may be underestimated in the outcome of children with CHD .  Language development in those with CHD may be improved with intervention targeting social-emotional competence ; further research is needed in this area Objective . Studies of developmental outcomes in children with congenital heart disease ( CHD ) frequently use assessment s conducted in infancy as primary endpoints . Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated , however . Methods . In the Boston Circulatory Arrest Study , 135 children with D-transposition of the great arteries repaired by arterial switch operation  were administered the  Bayley Scales of Infant Development  and the Fagan Test of Infant Intelligence  at 1 year of age and the Wechsler Intelligence Scale for Children , Third Edition and the Wechsler Individual Achievement Test at 8 years . Results . Although most 1-year test scores were significantly associated with 8-year test scores , the amounts of shared variance were modest ( < 10 % ) . All 1-year test scores had poor sensitivity ( 16%–32 % ) and poor positive predictive value ( 35%–42 % ) but good specificity ( 80%–93 % ) and negative predictive value ( 78%–79 % ) . More than half of the children with low scores at 8 years ( ≤85 ) had had scores > 84 at 1 year . Conclusion . This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years , many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores . Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative , intraoperative , and postoperative factors OBJECTIVE To test the hypothesis that postoperative length of stay ( LOS ) after infant heart surgery  might be an easily measured surrogate marker for various events that culminate in later adverse cognitive outcome . METHODS Among 160 eligible patients with D-transposition of the great arteries undergoing reparative surgery in infancy , 155 ( 97 % ) were reevaluated at age 8 years with IQ and achievement testing . We explored whether LOS quartiles were associated with these outcomes when adjusting for perioperative and sociodemographic variables . RESULTS Longer cardiac intensive care unit ( CICU ) LOS quartiles were associated at age 8 years with lower full-scale IQ ( P=.02 ) , lower verbal IQ ( P=.02 ) , and with tendencies toward lower performance IQ ( P=.08 ) and math achievement ( P=.08 ) in adjusted models . Compared with patients in the first quartile of CICU LOS , those in the fourth quartile had mean scores for full-scale IQ that were lower by 7.2 points ( P=.01 ) ; verbal IQ , 7.3 points ( P=.02 ) ; performance IQ , 5.8 points ( P=.05 ) ; and math achievement , 6.0 points ( P=.07 ) . Analyses on hospital LOS quartile were similar . CONCLUSIONS Longer postoperative LOS is associated with worse later cognitive function , even when adjusted for perioperative events , perfusion times , and sociodemographic variables . Further research is necessary to determine the mechanisms underlying this relation
Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
AIM ( 1 ) To systematic ally review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease ( CHD ) who underwent early surgery ; ( 2 ) to run a meta-regression analysis on the Bayley Scales of Infant Development , Second Edition Mental Developmental Index and Psychomotor Developmental Index ( PDI ) of infants up to 24 months and IQs of preschool-aged children to adolescents ; ( 3 ) to assess associations between perioperative risk factors and outcomes .