51
|
Cabrera-Mino C, Roy B, Woo MA, Singh S, Moye S, Halnon NJ, Lewis AB, Kumar R, Pike NA. Reduced brain mammillary body volumes and memory deficits in adolescents who have undergone the Fontan procedure. Pediatr Res 2020; 87:169-175. [PMID: 31499515 PMCID: PMC6962527 DOI: 10.1038/s41390-019-0569-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/08/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adolescents with single ventricle heart disease (SVHD) who have undergone the Fontan procedure show cognitive/memory deficits. Mammillary bodies are key brain sites that regulate memory; however, their integrity in SVHD is unclear. We evaluated mammillary body (MB) volumes and their associations with cognitive/memory scores in SVHD and controls. METHODS Brain MRI data were collected from 63 adolescents (25 SVHD; 38 controls) using a 3.0-Tesla MRI scanner. Cognition and memory were assessed using Montreal Cognitive Assessment (MoCA) and Wide Range Assessment of Memory and Learning 2. MB volumes were calculated and compared between groups (ANCOVA, covariates: age, sex, and total brain volume [TBV]). Partial correlations and linear regression were performed to examine associations between volumes and cognitive scores (covariates: age, sex, and TBV). RESULTS SVHD group showed significantly lower MoCA and WRAML2 scores over controls. MB volumes were significantly reduced in SVHD over controls. After controlling for age, sex, and TBV, MB volumes correlated with MoCA and delayed memory recall scores in SVHD and controls. CONCLUSION Adolescents with SVHD show reduced MB volumes associated with cognitive/memory deficits. Potential mechanisms of volume losses may include developmental and/or hypoxic/ischemic-induced processes. Providers should screen for cognitive deficits and explore possible interventions to improve memory.
Collapse
Affiliation(s)
| | - Bhaswati Roy
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Mary A. Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Sadhana Singh
- Departments of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Stefanie Moye
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Nancy J. Halnon
- Division of Pediatric Cardiology, University of California Los Angeles, Los Angeles, CA
| | - Alan B. Lewis
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Rajesh Kumar
- Departments of Anesthesiology, University of California Los Angeles, Los Angeles, CA,Departments of Radiological Sciences, University of California Los Angeles, Los Angeles, CA,Departments of Bioengineering, University of California Los Angeles, Los Angeles, CA,Departments of Brain Research Institute, University of California Los Angeles, Los Angeles, CA
| | - Nancy A. Pike
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
52
|
White BR, Rogers LS, Kirschen MP. Recent advances in our understanding of neurodevelopmental outcomes in congenital heart disease. Curr Opin Pediatr 2019; 31:783-788. [PMID: 31693588 PMCID: PMC6852883 DOI: 10.1097/mop.0000000000000829] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients with congenital heart disease (CHD) suffer from a pattern of neurodevelopmental abnormalities including deficits in language and executive function. In this review, we summarize recent studies that examine these outcomes, their risk factors, possible biomarkers, and attempts to develop therapeutic interventions. RECENT FINDINGS The latest literature has highlighted the role of genetics in determining neurologic prognosis, as we have increased our understanding of potentially modifiable perioperative risk factors. The role of potentially neurotoxic medical therapies has become more salient. One recent focus has been how neurodevelopment affects quality of life and leads to a high prevalence of mental illness. Neuroimaging advances have provided new insights into the pathogenesis of deficits. SUMMARY Although many risk factors in CHD are not modifiable, there is promise for interventions to improve neurodevelopmental outcomes in patients with CHD. Biomarkers are needed to better understand the timing and prognosis of injury and to direct therapy. Research into psychosocial interventions is urgently needed to benefit the many survivors with CHD.
Collapse
Affiliation(s)
- Brian R. White
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Lindsay S. Rogers
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Matthew P. Kirschen
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
53
|
Hiraiwa A, Ibuki K, Tanaka T, Hirono K, Miya K, Yoshimura N, Ichida F. Toddler Neurodevelopmental Outcomes Are Associated With School-Age IQ in Children With Single Ventricle Physiology. Semin Thorac Cardiovasc Surg 2019; 32:302-310. [PMID: 31698030 DOI: 10.1053/j.semtcvs.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 11/11/2022]
Abstract
To examine whether neurodevelopment at preschool age predicts IQ levels and needs for special education services in school-age children with single ventricle (SV) physiology. Thirty-five patients with SV physiology were assessed using the Bayley Scale of Infant and Toddler Development (BSID) II or III at 3 years and the Wechsler Intelligence Scale for Children-Fourth Edition (WISC) at 8 years. Whether the children were receiving special education services was also determined. Factors associated with the mental developmental index (MDI) of the BSID, the full-scale IQ (FSIQ) of the WISC, and special education services were also analyzed. The MDI and FSIQ of children with SV physiology were significantly lower than the values in healthy children (P < 0.01). The MDI at 3 years was moderately correlated with FSIQ at 8 years (P < 0.01, R2 = 0.41). Ten patients (28.6%) received special education services in their school. Children with MDI <85 were more likely than those with MDI ≥85 to require special education services at school age (53% and 10%, respectively, P < 0.01). Weight at birth and stage II were correlated with the MDI, extracorporeal circulation time at stage II was correlated with FSIQ, and age at Fontan operation was correlated with FSIQ and special education services. The toddler neurodevelopment index may predict not only IQ levels but also the need for special education services in school-age children. Children with low neurodevelopmental scores need to be followed closely for a long time.
Collapse
Affiliation(s)
- Akiko Hiraiwa
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan.
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Tomomi Tanaka
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kazushi Miya
- Faculty of Human Development, Department of Educational Sciences, University of Toyama, Toyama, Japan
| | - Naoki Yoshimura
- The 1(st) Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
54
|
du Plessis K, d’Udekem Y. The Neurodevelopmental Outcomes of Patients With Single Ventricles Across the Lifespan. Ann Thorac Surg 2019; 108:1565-1572. [DOI: 10.1016/j.athoracsur.2019.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/27/2022]
|
55
|
Goldberg CS, Hu C, Brosig C, Gaynor JW, Mahle WT, Miller T, Mussatto KA, Sananes R, Uzark K, Trachtenberg F, Pizarro C, Pemberton VL, Lewis AB, Li JS, Jacobs JP, Cnota J, Atz AM, Lai WW, Bellinger D, Newburger JW. Behavior and Quality of Life at 6 Years for Children With Hypoplastic Left Heart Syndrome. Pediatrics 2019; 144:e20191010. [PMID: 31628208 PMCID: PMC6856798 DOI: 10.1542/peds.2019-1010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We measured behavioral, quality of life (QoL), and functional status outcomes for 6-year-old children with hypoplastic left heart syndrome enrolled in the Single Ventricle Reconstruction Trial. We sought to compare these outcomes with those in the normative population and to analyze risk factors for worse outcomes within the single-ventricle group. METHODS Parent-response instruments included the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) (primary outcome), Behavior Assessment System for Children 2, Pediatric Quality of Life Inventory 4.0, and other measures of QoL and functional status. We compared subjects with those in the normative sample using 1-sample Wilcoxon rank tests and assessed outcome predictors using multivariable regression. RESULTS Of 325 eligible patients, 250 (77%) participated. Compared with population norms, participants had lower scores on the Vineland-II motor skills domain (90 ± 17 vs 100 ± 15; P < .001), with 11% scoring >2 SDs below the normative mean. On nearly all major domains, more study subjects (3.3%-19.7%) scored outside the normal range than anticipated for the general population. Independent risk factors for lower Vineland-II scores included perioperative extracorporeal membrane oxygenation, male sex, use of regional cerebral perfusion, catheterization after stage 2 operation, visual problems, seizure history, and more complications after 2 years (R 2 = 0.32). Independent predictors of worse Behavior Assessment System for Children 2 (R 2 = 0.07-0.20) and Pediatric Quality of Life Inventory 4.0 (R 2 = 0.17-0.25) domain scores also included sociodemographic factors and measures of morbidity and/or greater course complexity. CONCLUSIONS At 6 years, children with hypoplastic left heart syndrome had difficulty in areas of adaptive behavior, behavioral symptoms, QoL, and functional status. Principal risks for adverse outcomes include sociodemographic factors and measures of greater course complexity. However, models reveal less than one-third of outcome variance.
Collapse
Affiliation(s)
- Caren S Goldberg
- Department of Pediatrics, Medical School, University of Michigan and Michigan Medicine, Ann Arbor, Michigan;
| | - Chenwei Hu
- New England Research Institutes, Watertown, Massachusetts
| | - Cheryl Brosig
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - J William Gaynor
- Pediatric Cardiothoracic Surgery, School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William T Mahle
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Thomas Miller
- Department of Pediatrics, and The University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - Kathleen A Mussatto
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Renee Sananes
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Canada
| | - Karen Uzark
- Department of Pediatrics, Medical School, University of Michigan and Michigan Medicine, Ann Arbor, Michigan
| | | | - Christian Pizarro
- Department of Surgery, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Victoria L Pemberton
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan B Lewis
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer S Li
- Department of Pediatrics, Duke University, Durham, North Carolina
- Department of Pediatrics, East Carolina University, Greenville, North Carolina
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | | | - James Cnota
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Wyman W Lai
- Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - David Bellinger
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; and
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; and
| |
Collapse
|
56
|
Seed M. Searching for modifiable risk factors for neurodevelopment in congenital heart disease: Lessons from the Giessen/Zurich hypoplastic left heart syndrome experience. Int J Cardiol 2019; 291:50-51. [PMID: 31151765 DOI: 10.1016/j.ijcard.2019.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Mike Seed
- Cardiology, Hospital for Sick Children, Toronto, Canada.
| |
Collapse
|
57
|
Challenges, opportunities and solutions in hypoplastic left heart syndrome: Surveillance strategies for the patient with HLHS and a Fontan circulation. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
58
|
Romanowicz J, Leonetti C, Dhari Z, Korotcova L, Ramachandra SD, Saric N, Morton PD, Bansal S, Cheema A, Gallo V, Jonas RA, Ishibashi N. Treatment With Tetrahydrobiopterin Improves White Matter Maturation in a Mouse Model for Prenatal Hypoxia in Congenital Heart Disease. J Am Heart Assoc 2019; 8:e012711. [PMID: 31331224 PMCID: PMC6761654 DOI: 10.1161/jaha.119.012711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023]
Abstract
Background Reduced oxygen delivery in congenital heart disease causes delayed brain maturation and white matter abnormalities in utero. No treatment currently exists. Tetrahydrobiopterin (BH4) is a cofactor for neuronal nitric oxide synthase. BH4 availability is reduced upon NOS activation, such as during hypoxic conditions, and leads to toxin production. We hypothesize that BH4 levels are depleted in the hypoxic brain and that BH4 replacement therapy mitigates the toxic effects of hypoxia on white matter. Methods and Results Transgenic mice were used to visualize oligodendrocytes. Hypoxia was introduced during a period of white matter development equivalent to the human third trimester. BH4 was administered during hypoxia. BH4 levels were depleted in the hypoxic brain by direct quantification (n=7-12). The proliferation (n=3-6), apoptosis (n=3-6), and developmental stage (n=5-8) of oligodendrocytes were determined immunohistologically. Total oligodendrocytes increased after hypoxia, consistent with hypoxia-induced proliferation seen previously; however, mature oligodendrocytes were less prevalent in hypoxia, and there was accumulation of immature oligodendrocytes. BH4 treatment improved the mature oligodendrocyte number such that it did not differ from normoxia, and accumulation of immature oligodendrocytes was not observed. These results persisted beyond the initial period of hypoxia (n=3-4). Apoptosis increased with hypoxia but decreased with BH4 treatment to normoxic levels. White matter myelin levels decreased following hypoxia by western blot. BH4 treatment normalized myelination (n=6-10). Hypoxia worsened sensory-motor coordination on balance beam tasks, and BH4 therapy normalized performance (n=5-9). Conclusions Suboptimal BH4 levels influence hypoxic white matter abnormalities. Repurposing BH4 for use during fetal brain development may limit white matter dysmaturation in congenital heart disease.
Collapse
Affiliation(s)
- Jennifer Romanowicz
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
| | - Camille Leonetti
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Zaenab Dhari
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Ludmila Korotcova
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Shruti D. Ramachandra
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Nemanja Saric
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Paul D. Morton
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Shivani Bansal
- Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonDC
| | - Amrita Cheema
- Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonDC
| | - Vittorio Gallo
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Richard A. Jonas
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| | - Nobuyuki Ishibashi
- Children's National Heart InstituteChildren's National Health SystemWashingtonDC
- Center for Neuroscience ResearchChildren's National Health SystemWashingtonDC
| |
Collapse
|
59
|
Wolfe KR, Brinton J, Di Maria MV, Meier M, Liptzin DR. Oxygen saturations and neurodevelopmental outcomes in single ventricle heart disease. Pediatr Pulmonol 2019; 54:922-927. [PMID: 30919581 DOI: 10.1002/ppul.24275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/20/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate whether the degree of hypoxemia following stage-I and stage-II palliative surgeries predicts neurodevelopmental outcomes at 14 months of age in children with single ventricle congenital heart disease (SVCHD). DESIGN We analyzed longitudinal data from two Pediatric Heart Network (PHN) randomized controlled trials, with a total of 328 subjects. Oxygen saturations, measured via pulse oximetry, at time of discharge from stage-I and stage-II surgeries were the primary predictors of interest, and Bayley Scales of Infant Development-II (BSID-II) scores at 14 months old were the primary outcome measure. Relevant covariates from previously-published PHN studies were also included in regression models. RESULTS Oxygen saturations at time of discharge from stage-I and stage-II surgeries were not related to BSID-II scores. Having one or more oxygen saturation measurements below 80% was also not associated with BSID-II scores, and neither was change in oxygen saturations over time. These relationships were not altered by inclusion of relevant covariates. CONCLUSIONS In this large cohort of children with SVCHD, oxygen saturations post-stage-I and post-stage-II palliation surgeries as measured via pulse oximetry were not associated with neurodevelopmental outcomes at 14 months of age. The relationship between oxygen saturations and neurodevelopment in SVCHD is likely complex, and neurodevelopment is known to be affected by a number of factors. Pulse oximetry may also be an insufficient proxy for cerebral oxygen delivery. Clinically, pulse oximetry readings during the interstage and post-stage-II surgery periods are not a reliable predictor of future neurodevelopmental risk.
Collapse
Affiliation(s)
- Kelly R Wolfe
- Pediatric Neurology, University of Colorado School of Medicine and Children's Hospital, Aurora, Colorado
| | - John Brinton
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Michael V Di Maria
- Heart Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Maxene Meier
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Deborah R Liptzin
- Pediatric Pulmonary Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| |
Collapse
|
60
|
The association between feeding protocol compliance and weight gain following high-risk neonatal cardiac surgery. Cardiol Young 2019; 29:594-601. [PMID: 31133078 DOI: 10.1017/s1047951119000222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions' feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols. METHODS Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals. RESULTS Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates. CONCLUSIONS High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.
Collapse
|
61
|
Goldstone AB, Baiocchi M, Wypij D, Stopp C, Andropoulos DB, Atallah J, Atz AM, Beca J, Donofrio MT, Duncan K, Ghanayem NS, Goldberg CS, Hövels-Gürich H, Ichida F, Jacobs JP, Justo R, Latal B, Li JS, Mahle WT, McQuillen PS, Menon SC, Pike NA, Pizarro C, Shekerdemian LS, Synnes A, Williams IA, Bellinger DC, Newburger J, Gaynor JW. The Bayley-III scale may underestimate neurodevelopmental disability after cardiac surgery in infants. Eur J Cardiothorac Surg 2019; 57:63-71. [DOI: 10.1093/ejcts/ezz123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Neurodevelopmental disability is the most common complication among congenital heart surgery survivors. The Bayley scales are standardized instruments to assess neurodevelopment. The most recent edition (Bayley Scales of Infant and Toddler Development 3rd Edition, Bayley-III) yields better-than-expected scores in typically developing and high-risk infants than the second edition (Bayley Scales of Infant Development 2nd Edition, BSID-II). We compared BSID-II and Bayley-III scores in infants undergoing cardiac surgery.
METHODS
We evaluated 2198 infants who underwent operations with cardiopulmonary bypass between 1996 and 2009 at 26 institutions. We used propensity score matching to limit confounding by indication in a subset of patients (n = 705).
RESULTS
Overall, unadjusted Bayley-III motor scores were higher than BSID-II Psychomotor Development Index scores (90.7 ± 17.2 vs 77.6 ± 18.8, P < 0.001), and unadjusted Bayley-III composite cognitive and language scores were higher than BSID-II Mental Development Index scores (92.0 ± 15.4 vs 88.2 ± 16.7, P < 0.001). In the propensity-matched analysis, Bayley-III motor scores were higher than BSID-II Psychomotor Development Index scores [absolute difference 14.1, 95% confidence interval (CI) 11.7–17.6; P < 0.001] and the Bayley-III classified fewer children as having severe [odds ratio (OR) 0.24; 95% CI 0.14–0.42] or mild-to-moderate impairment (OR 0.21; 95% CI 0.14–0.32). The composite of Bayley-III cognitive and language scores was higher than BSID-II Mental Development Index scores (absolute difference 4.0, 95% CI 1.4–6.7; P = 0.003), but there was no difference between Bayley editions in the proportion of children classified as having severe cognitive and language impairment.
CONCLUSIONS
The Bayley-III yielded higher scores than the BSID-II and classified fewer children as severely impaired. The systematic bias towards higher scores with the Bayley-III precludes valid comparisons between early and contemporary cardiac surgery cohorts.
Collapse
Affiliation(s)
- Andrew B Goldstone
- Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | | | - Joseph Atallah
- Stollery Children’s Hospital, Western Canadian Complex Pediatric Therapies Follow-up Program, Edmonton, AB, Canada
| | - Andrew M Atz
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - John Beca
- Starship Children’s Hospital, Auckland, New Zealand
| | | | - Kim Duncan
- Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Nancy S Ghanayem
- Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Jeffrey P Jacobs
- Johns Hopkins All Children’s Heart Institute, St. Petersburg, FL, USA
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Shaji C Menon
- Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Nancy A Pike
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Anne Synnes
- University of British Columbia, Vancouver, BC, Canada
| | - Ismée A Williams
- New York-Presbyterian Morgan Stanley Children’s Hospital of New York, New York, NY, USA
| | | | | | - J William Gaynor
- Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
62
|
Marks KP, Madsen Sjö N, Wilson P. Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review. Dev Med Child Neurol 2019; 61:419-430. [PMID: 30246256 DOI: 10.1111/dmcn.14044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities. METHOD The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis. RESULTS US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial. INTERPRETATION Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts. WHAT THIS PAPER ADDS General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.
Collapse
Affiliation(s)
- Kevin P Marks
- Department of Pediatrics, PeaceHealth Medical Group, Eugene, OR, USA
| | - Nina Madsen Sjö
- National Research Centre for Disadvantaged Children and Youth, University College Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
63
|
Denniss DL, Sholler GF, Costa DSJ, Winlaw DS, Kasparian NA. Need for Routine Screening of Health-Related Quality of Life in Families of Young Children with Complex Congenital Heart Disease. J Pediatr 2019; 205:21-28.e2. [PMID: 30366775 DOI: 10.1016/j.jpeds.2018.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess health-related quality of life (HRQOL) in families of young children with complex congenital heart disease (CHD), and identify the demographic, clinical, and psychosocial factors that place these children and their mothers at greater risk of vulnerability. STUDY DESIGN This cross-sectional study took place from June 2015 to October 2016 at The Sydney Children's Hospitals Network Cardiac Service, Australia. Mothers of a child aged 1-5 years with either single ventricle CHD or CHD requiring neonatal biventricular repair were invited to participate. Eighty-seven mothers completed a suite of validated measures, including the Pediatric Quality of Life Inventory, which assessed the outcomes of child and maternal HRQOL. RESULTS Sixty percent of children with single ventricle CHD and 25% of children with biventricular repair had total Pediatric Quality of Life Inventory scores within the at-risk range. Lower child HRQOL was strongly associated with single ventricle CHD (β = -0.38; P < .001), physical comorbidity (β = -0.32; P = .001), feeding difficulties (β = -0.26; P = .008), and greater maternal psychological stress (β = -0.18; P = .045), accounting for 52% of the variance in child HRQOL. Lower maternal HRQOL was strongly associated with poorer family functioning (β = 0.61; P < .001), greater maternal psychological stress (β = -0.23; P = .004), child physical comorbidity (β = -0.17; P = .01), and a 'difficult' child temperament (β = -0.14; P = .01), accounting for 73% of the variance in maternal HRQOL. CONCLUSIONS Lower HRQOL is common in young children with complex CHD, particularly single ventricle CHD. Several predictors of HRQOL are potentially modifiable, offering possible pathways for prevention and early intervention. Routine screening is a necessary first step toward developing models of care to improve HRQOL in this population.
Collapse
Affiliation(s)
- Dominique L Denniss
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia
| | - Gary F Sholler
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, North Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - David S Winlaw
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Nadine A Kasparian
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia.
| |
Collapse
|
64
|
Abstract
BACKGROUND Little is known about health-related quality of life in young children undergoing staged palliation for single-ventricle CHD. The aim of this study was to assess the impact of CHD on daily life in pre-schoolers with single-ventricle CHD and to identify determinants of health-related quality of life. METHOD Prospective two-centre cohort study assessing health-related quality of life using the Preschool Paediatric Cardiac Quality of Life Inventory in 46 children at a mean age of 38 months and 3 weeks. Children with genetic anomalies were excluded. Scores were compared with reference data of children with biventricular CHD. Multiple linear regression analysis was used to identify determinants of health-related quality of life. RESULTS Health-related quality of life in pre-schoolers with single-ventricle CHD was comparable to children with biventricular CHD. Preterm birth and perioperative variables were significant predictors of low health-related quality of life. Notably, pre-Fontan brain MRI findings and neurodevelopmental status were not associated with health-related quality of life. Overall, perioperative variables explained 24% of the variability of the total health-related quality of life score.InterpretationDespite substantial health-related burden, pre-schoolers with single-ventricle CHD showed good health-related quality of life. Less-modifiable treatment-related risk factors and preterm birth had the highest impact on health-related quality of life. Long-term follow-up assessment of self-reported health-related quality of life is needed to identify patients with poorer health-related quality of life and to initiate supportive care.
Collapse
|
65
|
Graham EM, Martin RH, Atz AM, Hamlin-Smith K, Kavarana MN, Bradley SM, Alsoufi B, Mahle WT, Everett AD. Association of intraoperative circulating-brain injury biomarker and neurodevelopmental outcomes at 1 year among neonates who have undergone cardiac surgery. J Thorac Cardiovasc Surg 2019; 157:1996-2002. [PMID: 30797587 DOI: 10.1016/j.jtcvs.2019.01.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/19/2018] [Accepted: 01/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neurodevelopmental disability is the most significant complication for survivors of infant surgery for congenital heart disease. In this study we sought to determine if perioperative circulating brain injury biomarker levels are associated with neurodevelopmental outcomes at 12 months. METHODS A secondary analysis of a randomized controlled trial of neonates who underwent cardiac surgery was performed. Glial fibrillary acidic protein (GFAP) was measured: (1) before skin incision; (2) immediately after bypass; (3) 4 and (4) 24 hours postoperatively. Linear regression models were used to determine an association with the highest levels of GFAP and Bayley Scales of Infant and Toddler Development third edition (BSID) composite scores. RESULTS There were 97 subjects who had cardiac surgery at a mean age of 9 ± 6 days and completed a BSID at 12.5 ± 0.6 months of age. Median (25th-75th percentile) levels of GFAP were 0.01 (0.01-0.02), 0.85 (0.40-1.55), 0.07 (0.05-0.11), and 0.03 (0.02-0.04) ng/mL at the 4 time points, respectively. In univariate analysis GFAP was negatively associated with cognitive, language, and motor composite scores. GFAP levels immediately after bypass differed between institutions; 1.57 (0.92-2.48) versus 0.77 (0.36-1.21) ng/mL (P = .01). After adjusting for center and potential confounders, GFAP was independently associated with BSID motor score (P = .04). CONCLUSIONS Higher GFAP levels at the time of neonatal cardiac operations were independently associated with decreased BSID motor scores at 12 months. GFAP might serve as a diagnostic means to acutely identify perioperative brain-specific injury and serve as a benchmark of therapeutic efficacy for investigational treatments, discriminate center-specific effects, and provide early prognostic information for intervention.
Collapse
Affiliation(s)
- Eric M Graham
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
| | - Renee' H Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Andrew M Atz
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Kasey Hamlin-Smith
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Minoo N Kavarana
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Scott M Bradley
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Bahaaldin Alsoufi
- Department of Cardiothoracic Surgery, Children's Healthcare of Atlanta and Emory University, Atlanta, Ga
| | - William T Mahle
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, Ga
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins University, Baltimore, Md
| |
Collapse
|
66
|
Heye KN, Rousson V, Knirsch W, Beck I, Liamlahi R, Bernet V, Dave H, Latal B. Growth and Intellectual Abilities of Six-Year-Old Children with Congenital Heart Disease. J Pediatr 2019; 204:24-30.e10. [PMID: 30340933 DOI: 10.1016/j.jpeds.2018.08.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/20/2018] [Accepted: 08/23/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine growth and its relationship to IQ in children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery within the first year of life. STUDY DESIGN Prospective single-center cohort study on 143 children (91 males) with different types of CHD (29 univentricular). Children with recognized genetic disorders were excluded. Growth (weight, height, and head circumference [HC]) was assessed at birth, before surgery, and at 1, 4, and 6 years and compared with Swiss growth charts. IQ was assessed at 6 years using standardized tests. Univariate and multivariable linear regressions were performed to determine predictors of HC and IQ at 6 years. RESULTS HC at birth was in the low average range (33rd percentile, P = .03), and weight (49th percentile, P = .23) and length (47th percentile, P = .06) were normal. All growth measures declined until the first surgery, with a catch-up growth until 6 years for height (44th percentile, P = .07) but not for weight (39th percentile, P = .003) or for HC (23rd percentile, P < .001). Children undergoing univentricular palliation showed poorer height growth than other types of CHD (P = .01). Median IQ at 6 years was 95 (range 50-135). Lower IQ at 6 years was independently predicted by lower HC at birth, lower socioeconomic status, older age at first bypass surgery, and longer length of intensive care unit stay. CONCLUSIONS Smaller HC at birth and postnatal factors are predictive of impaired intellectual abilities at school age. Early identification should alert clinicians to provide early childhood interventions to optimize developmental potential.
Collapse
Affiliation(s)
- Kristina Nadine Heye
- Child Development Center, University Children's Hospital, Zurich, Switzerland; Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland.
| | - Valentin Rousson
- Children's Research Center, University Children's Hospital, Zurich, Switzerland; Division of Biostatistics, Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Ingrid Beck
- Child Development Center, University Children's Hospital, Zurich, Switzerland
| | - Rabia Liamlahi
- Child Development Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Vera Bernet
- Children's Research Center, University Children's Hospital, Zurich, Switzerland; Neonatology and Pediatric Intensive Care Unit, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Children's Research Center, University Children's Hospital, Zurich, Switzerland; Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | | |
Collapse
|
67
|
Sánchez O, Ruiz-Romero A, Domínguez C, Ferrer Q, Ribera I, Rodríguez-Sureda V, Alijotas J, Arévalo S, Carreras E, Cabero L, Llurba E. Brain angiogenic gene expression in fetuses with congenital heart disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:734-738. [PMID: 29205570 DOI: 10.1002/uog.18977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/09/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess potential differences in the expression of antiangiogenic and angiogenic factors and of genes associated with chronic hypoxia in cerebral tissue of euploid fetuses with congenital heart disease (CHD) vs those without. METHODS Cerebral tissue was obtained from 15 fetuses with CHD and 12 control fetuses that had undergone termination of pregnancy. Expression profiles of the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1), the angiogenic vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PlGF), and of genes associated with chronic hypoxia were determined by real-time polymerase chain reaction in tissue from the frontal cortex and the basal ganglia of the fetuses. RESULTS Expression of sFlt-1 was 48% higher in the frontal cortex (P = 0.0431) and 72% higher in the basal ganglia (P = 0.0369) of CHD fetuses compared with controls. The expression of VEGF-A was 60% higher (P = 0.0432) and that of hypoxia-inducible factor 2-alpha was 98% higher (P = 0.0456) in the basal ganglia of CHD fetuses compared with controls. No significant differences were observed between the two groups in the expression of PlGF and hypoxia-inducible factor 1-alpha. CONCLUSION An overall dysregulation of angiogenesis with a net balance towards an antiangiogenic environment was observed in the cerebral tissue of fetuses with CHD, suggesting that these fetuses may have an intrinsic angiogenic impairment that could contribute to impaired brain perfusion and abnormal neurological development later in life. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- O Sánchez
- Maternal and Child Health and Development Network (SAMID), RD16/0022/0015, Instituto de Salud Carlos III, Barcelona, Spain
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - A Ruiz-Romero
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Domínguez
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Q Ferrer
- Pediatric Cardiology Unit, Department of Pediatrics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - I Ribera
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Rodríguez-Sureda
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - J Alijotas
- Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Arévalo
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Cabero
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Llurba
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
68
|
Abstract
UNLABELLED Introduction The objective of this study was to prospectively validate the "Brief Developmental Assessment", which is a new early recognition tool for neurodevelopmental abnormalities in children with heart disease that was developed for use by cardiac teams. METHODS This was a prospective validation study among a representative sample of 960 pre-school children with heart disease from three United Kingdom tertiary cardiac centres who were analysed grouped into five separate age bands. RESULTS The "Brief Developmental Assessment" was successfully validated in the older four age bands, but not in the youngest representing infants under the age of 4 months, as pre-set validation thresholds were met - lower 95% confidence limit for the correlation coefficient above 0.75 - in terms of agreement of scores between two raters and with an external measure the "Mullen Scales of Early Learning". On the basis of American Association of Pediatrics Guidelines, which state that the sensitivity and specificity of a developmental screening tool should fall between 70 and 80%, "Brief Developmental Assessment" outcome of Red meets this threshold for detection of Mullen scores >2 standard deviations below the mean. CONCLUSION The "Brief Developmental Assessment" may be used to improve the quality of assessment of children with heart disease. This will require a training package for users and a guide to action for abnormal results. Further research is needed to determine how best to deploy the "Brief Developmental Assessment" at different time points in children with heart disease and to determine the management strategy in infants younger than 4 months old.
Collapse
|
69
|
Klin A, Jones W. An agenda for 21st century neurodevelopmental medicine: lessons from autism. Rev Neurol 2018; 66:S3-S15. [PMID: 29516447 PMCID: PMC6606044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The future of neurodevelopmental medicine has the potential of situating child neurology at the forefront of a broad-based public health effort to optimize neurodevelopmental outcomes of children born with high-prevalence and diverse genetic, pre- and peri-natal, and environmental burdens compromising early brain development and leading to lifetime disabilities. Building on advancements in developmental social neuroscience and in implementation science, this shift is already occurring in the case of emblematic neurodevelopmental disorders such as autism. Capitalizing on early neuroplasticity and on quantification of trajectories of social-communicative development, new technologies are emerging for high-throughput and cost-effective diagnosis and for community-viable delivery of powerful treatments, in seamless integration across previously fragmented systems of healthcare delivery. These solutions could be deployed in the case of other groups of children at greater risk for autism and communication delays, such as those born extremely premature or with congenital heart disease. The galvanizing concept in this aspirational future is a public health focus on promoting optimal conditions for early brain development, not unlike current campaigns promoting pre-natal care, nutrition or vaccination.
Collapse
Affiliation(s)
- A Klin
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
| | - W Jones
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
| |
Collapse
|
70
|
Nieves JA, Rudd NA, Dobrolet N. Home surveillance monitoring for high risk congenital heart newborns: Improving outcomes after single ventricle palliation - why, how & results. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
71
|
Bucholz EM, Sleeper LA, Newburger JW. Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set. J Am Heart Assoc 2018; 7:e007065. [PMID: 29420218 PMCID: PMC5850235 DOI: 10.1161/jaha.117.007065] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with single ventricle heart disease require frequent interventions and follow-up. Low socioeconomic status (SES) may limit access to high-quality care and place these children at risk for poor long-term outcomes. METHODS AND RESULTS Data from the SVR (Pediatric Heart Network Single Ventricle Reconstruction Trial Public Use) data set were used to examine the relationship of US neighborhood SES with 30-day and 1-year mortality or cardiac transplantation and length of stay among neonates undergoing the Norwood procedure (n=525). Crude rates of death or transplantation at 1 year after Norwood were highest for patients living in neighborhoods with low SES (lowest tertile 37.0% versus middle tertile 31.0% versus highest tertile 23.6%, P=0.024). After adjustment for patient demographics, birth characteristics, and anatomy, patients in the highest SES tertile had significantly lower risk of death or transplant than patients in the lowest SES tertile (hazard ratio 0.62, 95% confidence interval, 0.40, 0.96). When SES was examined continuously, the hazard of 1-year death or transplant decreased steadily with increasing neighborhood SES. Hazard ratios for 30-day transplant-free survival and 1-year transplant-free survival were similar in magnitude. There were no significant differences in length of stay following the Norwood procedure by SES. CONCLUSIONS Low neighborhood SES is associated with worse 1-year transplant-free survival after the Norwood procedure, suggesting that socioeconomic and environmental factors may be important determinants of outcome in critical congenital heart disease. Future studies should investigate aspects of SES and environment amenable to intervention. CLINICAL TRIAL REGISTRATION URL:http://www.clinicaltrials.gov> http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
Collapse
Affiliation(s)
- Emily M Bucholz
- Department of Medicine, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lynn A Sleeper
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| |
Collapse
|
72
|
Abstract
OBJECTIVE Children with hypoplastic left heart syndrome are at a risk for neurodevelopmental delays. Current guidelines recommend systematic evaluation and management of neurodevelopmental outcomes with referral for early intervention services. The Single Ventricle Reconstruction Trial represents the largest cohort of children with hypoplastic left heart syndrome ever assembled. Data on life events and resource utilisation have been collected annually. We sought to determine the type and prevalence of early intervention services used from age 1 to 4 years and factors associated with utilisation of services. METHODS Data from 14-month neurodevelopmental assessment and annual medical history forms were used. We assessed the impact of social risk and geographic differences. Fisher exact tests and logistic regression were used to evaluate associations. RESULTS Annual medical history forms were available for 302 of 314 children. Greater than half of the children (52-69%) were not receiving services at any age assessed, whereas 20-32% were receiving two or more therapies each year. Utilisation was significantly lower in year 4 (31%) compared with years 1-3 (with a range from 40 to 48%) (p<0.001). Social risk factors were not associated with the use of services at any age but there were significant geographic differences. Significant delay was reported by parents in 18-43% of children at ages 3 and 4. CONCLUSION Despite significant neurodevelopmental delays, early intervention service utilisation was low in this cohort. As survival has improved for children with hypoplastic left heart syndrome, attention must shift to strategies to optimise developmental outcomes, including enrolment in early intervention when merited.
Collapse
|
73
|
Jin SC, Homsy J, Zaidi S, Lu Q, Morton S, DePalma SR, Zeng X, Qi H, Chang W, Sierant MC, Hung WC, Haider S, Zhang J, Knight J, Bjornson RD, Castaldi C, Tikhonoa IR, Bilguvar K, Mane SM, Sanders SJ, Mital S, Russell M, Gaynor W, Deanfield J, Giardini A, Porter GA, Srivastava D, Lo CW, Shen Y, Watkins WS, Yandell M, Yost HJ, Tristani-Firouzi M, Newburger JW, Roberts AE, Kim R, Zhao H, Kaltman JR, Goldmuntz E, Chung WK, Seidman JG, Gelb BD, Seidman CE, Lifton RP, Brueckner M. Contribution of rare inherited and de novo variants in 2,871 congenital heart disease probands. Nat Genet 2017; 49:1593-1601. [PMID: 28991257 PMCID: PMC5675000 DOI: 10.1038/ng.3970] [Citation(s) in RCA: 515] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022]
Abstract
Congenital heart disease (CHD) is the leading cause of mortality from birth defects. Here, exome sequencing of a single cohort of 2,871 CHD probands, including 2,645 parent-offspring trios, implicated rare inherited mutations in 1.8%, including a recessive founder mutation in GDF1 accounting for ∼5% of severe CHD in Ashkenazim, recessive genotypes in MYH6 accounting for ∼11% of Shone complex, and dominant FLT4 mutations accounting for 2.3% of Tetralogy of Fallot. De novo mutations (DNMs) accounted for 8% of cases, including ∼3% of isolated CHD patients and ∼28% with both neurodevelopmental and extra-cardiac congenital anomalies. Seven genes surpassed thresholds for genome-wide significance, and 12 genes not previously implicated in CHD had >70% probability of being disease related. DNMs in ∼440 genes were inferred to contribute to CHD. Striking overlap between genes with damaging DNMs in probands with CHD and autism was also found.
Collapse
Affiliation(s)
- Sheng Chih Jin
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
| | - Jason Homsy
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Samir Zaidi
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
| | - Qiongshi Lu
- Department of Biostatistics; Yale School of Public Health, New Haven, CT, USA
| | - Sarah Morton
- Division of Newborn Medicine, Department of Medicine, Boston Children’s Hospital, Boston, USA
| | | | - Xue Zeng
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
| | - Hongjian Qi
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY, USA
| | - Weni Chang
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Michael C. Sierant
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
| | - Wei-Chien Hung
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
| | - Shozeb Haider
- Department of Computational Chemistry, University College London School of Pharmacy, WC1N1AX, UK
| | - Junhui Zhang
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
| | - James Knight
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | | | | | - Irina R. Tikhonoa
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Kaya Bilguvar
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Shrikant M. Mane
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Stephan J. Sanders
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - William Gaynor
- Department of Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John Deanfield
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - Alessandro Giardini
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - George A. Porter
- Department of Pediatrics, University of Rochester Medical Center, The School of Medicine and Dentistry, Rochester, NY, USA
| | - Deepak Srivastava
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA 94158, USA
- Roddenberry Stem Cell Center at Gladstone, San Francisco, CA 94158, USA
- Departments of Pediatrics and Biochemistry & Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Cecelia W. Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15201, USA
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY, USA
| | - W. Scott Watkins
- Department of Human Genetics, Eccles Institute of Human Genetics, University of Utah and School of Medicine, Salt Lake City, UT, USA
| | - Mark Yandell
- Department of Human Genetics, Eccles Institute of Human Genetics, University of Utah and School of Medicine, Salt Lake City, UT, USA
- USTAR Center for Genetic Discovery, University of Utah, Salt Lake City, UT, USA
| | - H. Joseph Yost
- Department of Human Genetics, Eccles Institute of Human Genetics, University of Utah and School of Medicine, Salt Lake City, UT, USA
| | | | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Amy E. Roberts
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Richard Kim
- Pediatric Cardiac Surgery, Children’s Hospital of Los Angeles, Los Angeles, CA, USA
| | - Hongyu Zhao
- Department of Biostatistics; Yale School of Public Health, New Haven, CT, USA
| | - Jonathan R. Kaltman
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, NHLBI/NIH, Bethesda, MD, USA
| | - Elizabeth Goldmuntz
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy K. Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
- Howard Hughes Medical Institute, Harvard University, Boston, MA, USA
| | - Richard P. Lifton
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, NY, USA
| | - Martina Brueckner
- Department of Genetics; Yale University School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
74
|
Abstract
OBJECTIVE Standardised developmental screening tools are important for the evaluation and management of developmental disorders in children with CHD; however, psychometric properties and clinical utility of screening tools, such as the Ages & Stages Questionnaires, Third Edition (ASQ-3), have not been examined in the CHD population. We hypothesised that the ASQ-3 would be clinically useful for this population. Study design ASQ-3 developmental classifications for 163 children with CHD at 6, 12, 24, and/or 36 months of age were compared with those obtained from concurrent developmental testing with the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS When ASQ-3 screening failure was defined as ⩾1 SD below the normative mean, specificity (⩾81.9%) and negative predictive value (⩾81.0%) were high across ASQ-3 areas. Sensitivity was high for gross motor skills (79.6%), increased with age for communication (35.7-100%), and generally decreased with age for problem solving (73.1-50.0%). When ASQ-3 screening failure was defined as ⩾2 SD below the normative mean, specificity (⩾93.6%) and positive predictive value (⩾74.5%) were generally high across ASQ-3 areas, but sensitivity was low (31.1%) to fair (62.8%). The ASQ-3 showed improved accuracy in predicting delays over clinical risk factors alone. CONCLUSIONS The ASQ-3 appears to be a clinically useful tool for screening development in children with CHD, although its utility varied on the basis of developmental area and time point. Clinicians are encouraged to refer children scoring ⩾1 SD below the normative mean on any ASQ-3 area for formal developmental evaluation.
Collapse
|
75
|
Texter K, Davis JAM, Phelps C, Cheatham S, Cheatham J, Galantowicz M, Feltes TF. Building a comprehensive team for the longitudinal care of single ventricle heart defects: Building blocks and initial results. CONGENIT HEART DIS 2017; 12:403-410. [DOI: 10.1111/chd.12459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/20/2017] [Accepted: 02/21/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Karen Texter
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
- Department of Pediatrics; The Ohio State University; Columbus Ohio USA
| | - Jo Ann M. Davis
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
| | - Christina Phelps
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
- Department of Pediatrics; The Ohio State University; Columbus Ohio USA
| | - Sharon Cheatham
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
- Department of Pediatrics; The Ohio State University; Columbus Ohio USA
| | - John Cheatham
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
- Department of Pediatrics; The Ohio State University; Columbus Ohio USA
| | - Mark Galantowicz
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
- Division of Cardiothoracic Surgery; Nationwide Children's Hospital; Columbus Ohio USA
| | - Timothy F. Feltes
- Division of Cardiology; Nationwide Children's Hospital; Columbus Ohio USA
- Department of Pediatrics; The Ohio State University; Columbus Ohio USA
| |
Collapse
|
76
|
Laraja K, Sadhwani A, Tworetzky W, Marshall AC, Gauvreau K, Freud L, Hass C, Dunbar-Masterson C, Ware J, Lafranchi T, Wilkins-Haug L, Newburger JW. Neurodevelopmental Outcome in Children after Fetal Cardiac Intervention for Aortic Stenosis with Evolving Hypoplastic Left Heart Syndrome. J Pediatr 2017; 184:130-136.e4. [PMID: 28233547 PMCID: PMC6343658 DOI: 10.1016/j.jpeds.2017.01.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/19/2016] [Accepted: 01/12/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To characterize neurodevelopmental outcomes after fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome and determine the risk factors for adverse neurodevelopment. STUDY DESIGN Questionnaires were mailed to families of children who underwent fetal aortic valvuloplasty from 2000 to 2012, and medical records were reviewed retrospectively. The primary outcome was the General Adaptive Composite score of the Adaptive Behavior Assessment System Questionnaire-Second Edition. Other questionnaires included the Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Ages and Stages, and Pediatric Quality of Life Inventory. RESULTS Among 69 eligible subjects, 52 (75%) completed questionnaires at median age of 5.5 (range 1.3-12) years; 30 (58%) had biventricular status circulation. The General Adaptive Composite mean score (92 ± 17) was lower than population norms (P < .001) and similar to published reports in patients with hypoplastic left heart syndrome without fetal intervention; scores in the single ventricular versus biventricular group were 97 ± 19 vs 89 ± 14, respectively (P = .10). On multivariable analysis, independent predictors of a lower General Adaptive Composite score were total hospital duration of stay in the first year of life (P = .001) and, when forced into the model, biventricular status (P = .02). For all other neurodevelopmental questionnaires (Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Ages and Stages, Pediatric Quality of Life Inventory), most subscale scores for patients with biventricular and single ventricular status were similar. CONCLUSION Children who underwent fetal aortic valvuloplasty have neurodevelopmental delay, similar to patients with hypoplastic left heart syndrome without fetal intervention. Achievement of biventricular circulation was not associated with better outcomes. We infer that innate patient factors and morbidity during infancy have the greatest effect on neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Kristin Laraja
- Departments of Cardiology, Boston Children’s Hospital,Departments of Pediatrics, Harvard Medical School, Boston, MA
| | - Anjali Sadhwani
- Departments of Psychiatry, Boston Children’s Hospital,Departments of Psychiatry, Harvard Medical School, Boston, MA
| | - Wayne Tworetzky
- Departments of Cardiology, Boston Children’s Hospital,Departments of Pediatrics, Harvard Medical School, Boston, MA
| | - Audrey C. Marshall
- Departments of Cardiology, Boston Children’s Hospital,Departments of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Departments of Cardiology, Boston Children’s Hospital,Departments of Pediatrics, Harvard Medical School, Boston, MA
| | - Lindsay Freud
- Departments of Cardiology, Boston Children’s Hospital,Departments of Pediatrics, Harvard Medical School, Boston, MA
| | - Cara Hass
- Departments of Cardiology, Boston Children’s Hospital
| | | | - Janice Ware
- Developmental Medicine Center, Boston Children’s Hospital,Departments of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Louise Wilkins-Haug
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,Departments of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Jane W. Newburger
- Departments of Cardiology, Boston Children’s Hospital,Departments of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
77
|
Morton PD, Ishibashi N, Jonas RA. Neurodevelopmental Abnormalities and Congenital Heart Disease: Insights Into Altered Brain Maturation. Circ Res 2017; 120:960-977. [PMID: 28302742 PMCID: PMC5409515 DOI: 10.1161/circresaha.116.309048] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 01/14/2023]
Abstract
In the past 2 decades, it has become evident that individuals born with congenital heart disease (CHD) are at risk of developing life-long neurological deficits. Multifactorial risk factors contributing to neurodevelopmental abnormalities associated with CHD have been identified; however, the underlying causes remain largely unknown, and efforts to address this issue have only recently begun. There has been a dramatic shift in focus from newly acquired brain injuries associated with corrective and palliative heart surgery to antenatal and preoperative factors governing altered brain maturation in CHD. In this review, we describe key time windows of development during which the immature brain is vulnerable to injury. Special emphasis is placed on the dynamic nature of cellular events and how CHD may adversely impact the cellular units and networks necessary for proper cognitive and motor function. In addition, we describe current gaps in knowledge and offer perspectives about what can be done to improve our understanding of neurological deficits in CHD. Ultimately, a multidisciplinary approach will be essential to prevent or improve adverse neurodevelopmental outcomes in individuals surviving CHD.
Collapse
Affiliation(s)
- Paul D Morton
- From the Center for Neuroscience Research and Children's National Heart Institute, Children's National Health System, Washington, DC
| | - Nobuyuki Ishibashi
- From the Center for Neuroscience Research and Children's National Heart Institute, Children's National Health System, Washington, DC.
| | - Richard A Jonas
- From the Center for Neuroscience Research and Children's National Heart Institute, Children's National Health System, Washington, DC.
| |
Collapse
|
78
|
Friedland-Little JM, Uzark K, Yu S, Lowery R, Aiyagari R, Hirsch-Romano JC. Functional Status and Quality of Life in Survivors of Extracorporeal Membrane Oxygenation After the Norwood Operation. Ann Thorac Surg 2017; 103:1950-1955. [PMID: 28223051 DOI: 10.1016/j.athoracsur.2016.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants who require extracorporeal membrane oxygenation (ECMO) support after a Norwood operation are at increased risk for early and late death compared with patients who do not require ECMO post-Norwood. Little is known about the effect that ECMO post-Norwood has on functional status and quality of life among long-term survivors. METHODS We prospectively evaluated functional status and health-related quality of life in 12 surviving patients (cases) and 19 corresponding patients (controls) from a previous retrospective case-control assessment of long-term survival in patients requiring ECMO post-Norwood. Functional status was assessed with the Vineland Adaptive Behavior Scale-II, and health-related quality of life was assessed with the Pediatric Quality of Life Inventory (PedsQL) core and cardiac modules. RESULTS There were no differences in demographics, extracardiac or genetic anomalies, or age at follow-up assessment between ECMO cases and non-ECMO controls. The Vineland Adaptive Behavior Scale-II scores were comparable between groups, with both groups demonstrating function in the normal range in all four domains tested. The only difference in PedsQL scores between cases and controls was perceived physical appearance, which was lower among ECMO survivors by both patient and proxy report. PedsQL scores of both groups were comparable to published scores for patients with single-ventricle congenital heart disease but generally lower than scores for the healthy population. CONCLUSIONS The requirement for ECMO support after a Norwood operation does not appear to significantly affect functional status or quality of life among the subset of patients who achieve long-term survival.
Collapse
Affiliation(s)
- Joshua M Friedland-Little
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington.
| | - Karen Uzark
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan
| | - Ray Lowery
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan
| | - Ranjit Aiyagari
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan
| | - Jennifer C Hirsch-Romano
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan; Section of Pediatric Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
79
|
Ringle ML, Wernovsky G. Functional, quality of life, and neurodevelopmental outcomes after congenital cardiac surgery. Semin Perinatol 2016; 40:556-570. [PMID: 27989374 DOI: 10.1053/j.semperi.2016.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Throughout the past few decades, advances in cardiology, neonatal intensive care, and surgical techniques have resulted in a growing cohort of thriving school-aged children with previously lethal complex congenital heart diseases. While survival has increased, there remains significant morbidity following repair including neurodevelopmental sequelae. Compared to children with a structurally normal heart, these infants and children have a higher frequency of abnormalities in tone, feeding, and delayed developmental milestones, as well as challenges with speech and learning disabilities, while a higher proportion of adolescents suffer from problems with processing speed, executive function, and a unique set of medical hardships related to exercise intolerance and obesity, medication burden, and mental health comorbidities. Innovative perioperative techniques and early psychosocial intervention in these young survivors has shown that despite the obstacles, the majority of these children can grow to have fulfilling lives with intelligence and social skills in the normal range. Additionally, a comprehensive medical home aids in optimizing the quality of life for these children and their families.
Collapse
Affiliation(s)
- Megan L Ringle
- Pediatric Residency, Nicklaus Children׳s Hospital, Miami Children׳s Health System, Miami, FL.
| | - Gil Wernovsky
- The Heart Program, Nicklaus Children׳s Hospital, Miami Children׳s Health System, 3100 SW 62nd Ave, Miami, FL 33155
| |
Collapse
|
80
|
Slicker J, Sables-Baus S, Lambert LM, Peterson LE, Woodard FK, Ocampo EC. Perioperative Feeding Approaches in Single Ventricle Infants: A Survey of 46 Centers. CONGENIT HEART DIS 2016; 11:707-715. [DOI: 10.1111/chd.12390] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | - Sharon Sables-Baus
- University of Colorado, College of Nursing; Children's Hospital Colorado; Aurora Colo USA
| | | | | | - Frances K. Woodard
- Medical University of South Carolina Children's Hospital; Charleston SC USA
| | - Elena C. Ocampo
- Baylor College of Medicine; Texas Children's Hospital; Houston Tex USA
| | | |
Collapse
|
81
|
Spillane NT, Kashyap S, Bateman D, Weindler M, Krishnamurthy G. Comparison of Feeding Strategies for Infants With Hypoplastic Left Heart Syndrome. World J Pediatr Congenit Heart Surg 2016; 7:446-53. [DOI: 10.1177/2150135116644641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/16/2016] [Indexed: 11/15/2022]
Abstract
Introduction: Infants with hypoplastic left heart syndrome are at risk for growth failure, particularly after stage 1 procedures. The effect of continuous enteral feedings on weight gain has not been previously investigated. Methods: A randomized controlled trial was performed in infants with hypoplastic left heart syndrome and single ventricle variants after stage 1 procedures. Eligible infants were randomized to a continuous and intermittent feeding regimen or an exclusive intermittent feeding regimen after stage 1 procedures and continued until hospital discharge. Anthropometric measures and markers of nutritional status were assessed throughout hospitalization. Results: Twenty-six infants completed the study. There were no significant differences in weight gain, growth, or nutritional status. Weight gain on full enteral feedings was 24.3 versus 23.6 g/d ( P = .88) for the combination (continuous and intermittent) versus intermittent feeding groups. Weight-for-age Z scores at discharge were −1.37 versus −1.2 ( P = .59) for the combination versus intermittent groups. Conclusions: No significant differences in weight gain, growth, or nutritional status were observed at hospital discharge between the two feeding strategies. Despite both groups achieving target daily weight gain after attaining full feeds, growth failure continued to be a problem after stage 1 procedures. Further strategies to improve growth during initial hospitalization are needed.
Collapse
Affiliation(s)
- Nicole T. Spillane
- Department of Pediatrics, Hackensack UMC, Rutgers University New Jersey Medical School, Hackensack, NJ, USA
| | - Sudha Kashyap
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - David Bateman
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Marilyn Weindler
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Ganga Krishnamurthy
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
82
|
Kumar P. Universal Pulse Oximetry Screening for Early Detection of Critical Congenital Heart Disease. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2016; 10:35-41. [PMID: 27279759 PMCID: PMC4892233 DOI: 10.4137/cmped.s33086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Abstract
Critical congenital heart disease (CCHD) is a major cause of infant death and morbidity worldwide. An early diagnosis and timely intervention can significantly reduce the likelihood of an adverse outcome. However, studies from the United States and other developed countries have shown that as many as 30%–50% of infants with CCHD are discharged after birth without being identified. This diagnostic gap is likely to be even higher in low-resource countries. Several large randomized trials have shown that the use of universal pulse-oximetry screening (POS) at the time of discharge from birth hospital can help in early diagnosis of these infants. The objective of this review is to share data to show that the use of POS for early detection of CCHD meets the criteria necessary for inclusion to the universal newborn screening panel and could be adopted worldwide.
Collapse
Affiliation(s)
- Praveen Kumar
- Associate Chair, Visiting Professor of Pediatrics, Department of Pediatrics, University of Illinois, Children's Hospital of Illinois, Peoria, IL, USA
| |
Collapse
|
83
|
Dykes JC, Al-mousily MF, Abuchaibe EC, Silva JN, Zadinsky J, Duarte D, Welch E. The incidence of chromosome abnormalities in neonates with structural heart disease. Heart 2016; 102:634-7. [DOI: 10.1136/heartjnl-2015-308650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/03/2016] [Indexed: 11/03/2022] Open
|
84
|
Homsy J, Zaidi S, Shen Y, Ware JS, Samocha KE, Karczewski KJ, DePalma SR, McKean D, Wakimoto H, Gorham J, Jin SC, Deanfield J, Giardini A, Porter GA, Kim R, Bilguvar K, López-Giráldez F, Tikhonova I, Mane S, Romano-Adesman A, Qi H, Vardarajan B, Ma L, Daly M, Roberts AE, Russell MW, Mital S, Newburger JW, Gaynor JW, Breitbart RE, Iossifov I, Ronemus M, Sanders SJ, Kaltman JR, Seidman JG, Brueckner M, Gelb BD, Goldmuntz E, Lifton RP, Seidman CE, Chung WK. De novo mutations in congenital heart disease with neurodevelopmental and other congenital anomalies. Science 2015; 350:1262-6. [PMID: 26785492 PMCID: PMC4890146 DOI: 10.1126/science.aac9396] [Citation(s) in RCA: 537] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Congenital heart disease (CHD) patients have an increased prevalence of extracardiac congenital anomalies (CAs) and risk of neurodevelopmental disabilities (NDDs). Exome sequencing of 1213 CHD parent-offspring trios identified an excess of protein-damaging de novo mutations, especially in genes highly expressed in the developing heart and brain. These mutations accounted for 20% of patients with CHD, NDD, and CA but only 2% of patients with isolated CHD. Mutations altered genes involved in morphogenesis, chromatin modification, and transcriptional regulation, including multiple mutations in RBFOX2, a regulator of mRNA splicing. Genes mutated in other cohorts examined for NDD were enriched in CHD cases, particularly those with coexisting NDD. These findings reveal shared genetic contributions to CHD, NDD, and CA and provide opportunities for improved prognostic assessment and early therapeutic intervention in CHD patients.
Collapse
Affiliation(s)
- Jason Homsy
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Samir Zaidi
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY, USA
| | - James S Ware
- Department of Genetics, Harvard Medical School, Boston, MA, USA. NIHR Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield NHS Foundation and Trust and Imperial College London, London, UK. National Heart & Lung Institute, Imperial College London, London, UK
| | - Kaitlin E Samocha
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Konrad J Karczewski
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Steven R DePalma
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Howard Hughes Medical Institute, Harvard University, Boston, MA, USA
| | - David McKean
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Hiroko Wakimoto
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Josh Gorham
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Sheng Chih Jin
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - John Deanfield
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - Alessandro Giardini
- Department of Cardiology, University College London and Great Ormond Street Hospital, London, UK
| | - George A Porter
- Department of Pediatrics, University of Rochester Medical Center, The School of Medicine and Dentistry, Rochester, NY, USA
| | - Richard Kim
- Section of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kaya Bilguvar
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | | | - Irina Tikhonova
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Shrikant Mane
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
| | - Angela Romano-Adesman
- Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Hongjian Qi
- Departments of Systems Biology and Biomedical Informatics, Columbia University Medical Center, New York, NY, USA. Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY, USA
| | - Badri Vardarajan
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Lijiang Ma
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Mark Daly
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Amy E Roberts
- Department of Cardiology, Children's Hospital Boston, Boston, MA, USA
| | - Mark W Russell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - J William Gaynor
- Department of Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Roger E Breitbart
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Ivan Iossifov
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | | | - Stephan J Sanders
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan R Kaltman
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, NHLBI/NIH, Bethesda, MD, USA
| | | | - Martina Brueckner
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.
| | - Bruce D Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elizabeth Goldmuntz
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. Howard Hughes Medical Institute, Yale University, New Haven, CT, USA.
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA. Howard Hughes Medical Institute, Harvard University, Boston, MA, USA. Cardiovascular Division, Brigham & Women's Hospital, Harvard University, Boston, MA, USA.
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
85
|
Hypoplastic left heart syndrome: How to improve late survival and quality of life. J Thorac Cardiovasc Surg 2015; 150:1401-3. [DOI: 10.1016/j.jtcvs.2015.08.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 11/20/2022]
|
86
|
Hoffman GM, Brosig CL, Bear LM, Tweddell JS, Mussatto KA. Effect of Intercurrent Operation and Cerebral Oxygenation on Developmental Trajectory in Congenital Heart Disease. Ann Thorac Surg 2015; 101:708-16. [PMID: 26542436 DOI: 10.1016/j.athoracsur.2015.08.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/13/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Children with congenital heart disease are at increased risk of abnormal neurodevelopment (ND). Demographic and perioperative physiologic factors have both been associated with developmental outcome. The acute physiologic effect of a surgical procedure, anesthesia, and hospitalization may offset any potential advantage gained from anatomic correction and circulatory palliation. The specific risk/benefit balance on ND outcome of the insult of the operation, offset by the benefit of improved anatomy and physiology, has not been addressed. We therefore sought to identify interval procedural and physiologic factors assessed at outpatient ND evaluation visits that were associated with outcome. METHODS The study included children with congenital heart disease at high risk for impaired ND performance with at least three ND assessments using the Bayley Scales of Infant Development-III during the first 3 years of life. The number of cardiac procedures, duration of hospitalization, feeding status, height, weight, and arterial, cerebral, and somatic oxygen saturations by near-infrared spectroscopy were recorded at each visit and used as predictors of language, motor, and cognitive composite scores and slopes (change over time) in general linear models. RESULTS Data on 178 children derived from 632 visits (median, 4 visits/child) were analyzed, with ages at first and last assessment of 7.7 and 30.2 months. Fifty-one had 1 ventricle (1V), 88 had 2 ventricles, and 39 had genetic syndrome conditions. Motor performance increased with age in all diagnostic categories. Cognitive and language performance increased with age in 1V patients but exhibited no significant change in 2-ventricle and genetic syndrome groups. At the first visit, 1V patients performed less well than 2-ventricle patients in the motor domain, but the rate of improvement was higher for 1V patients; by 24 months, there were no differences, and both groups were normal in all domains. Performance in genetic syndrome patients was below normal in all domains at the first visit and did not improve. Higher arterial saturation and narrower arterial-cerebral and arterial-somatic near-infrared spectroscopy saturation differences were associated with better or improving motor performance. Incremental cardiopulmonary bypass time, cumulative hospital length of stay, and tube feedings were risk factors in all domains. Total and incremental times for deep hypothermic circulatory arrest, extracorporeal membrane oxygenation, total open and total surgical procedures, and birth weight were not risk factors. CONCLUSIONS Patient physiologic status assessed by cerebral and somatic near-infrared spectroscopy is associated with ND performance. Incremental surgical procedures are not associated with ND performance when adjusted for cardiopulmonary bypass time and physiologic status. Treatment strategies that target improved physiologic status may also improve ND outcome.
Collapse
Affiliation(s)
- George M Hoffman
- Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Cheryl L Brosig
- Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laurel M Bear
- Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James S Tweddell
- Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | |
Collapse
|
87
|
Morton PD, Ishibashi N, Jonas RA, Gallo V. Congenital cardiac anomalies and white matter injury. Trends Neurosci 2015; 38:353-63. [PMID: 25939892 PMCID: PMC4461528 DOI: 10.1016/j.tins.2015.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 12/17/2022]
Abstract
Cardiac abnormalities are the most common birth defects. Derangement of circulatory flow affects many vital organs; without proper supply of oxygenated blood, the brain is particularly vulnerable. Although surgical interventions have greatly reduced mortality rates, patients often suffer an array of neurological deficits throughout life. Neuroimaging provides a macroscopic assessment of brain injury and has shown that white matter (WM) is at risk. Oligodendrocytes and myelinated axons have been identified as major targets of WM injury, but still little is known about how congenital heart anomalies affect the brain at the cellular level. Further integration of animal model studies and clinical research will define novel therapeutic targets and new standards of care to prevent developmental delay associated with cardiac abnormalities.
Collapse
Affiliation(s)
- Paul D Morton
- Center for Neuroscience Research and Children's National Heart Institute, Children's National Medical Center, Washington, DC 20010, USA
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research and Children's National Heart Institute, Children's National Medical Center, Washington, DC 20010, USA
| | - Richard A Jonas
- Center for Neuroscience Research and Children's National Heart Institute, Children's National Medical Center, Washington, DC 20010, USA
| | - Vittorio Gallo
- Center for Neuroscience Research and Children's National Heart Institute, Children's National Medical Center, Washington, DC 20010, USA.
| |
Collapse
|
88
|
Learning and evolving. Cardiol Young 2015; 25:984-90. [PMID: 25789419 DOI: 10.1017/s1047951115000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is an honour to present the Anthony Chang lecture at this 10th International Conference of the Pediatric Cardiac Intensive Care Society. I have had the privilege of knowing Dr Chang for over 20 years, and although we only worked for a short period of time together at the Children's Hospital, Boston, in the Cardiac Intensive Care Unit, we have remained close colleagues and friends since that time. The contributions of Dr Chang to the development of paediatric cardiac intensive care are very clear, based on his clinical expertise, research and scholarship, and the development of the Pediatric Cardiac Intensive Care Society in its early days. More than this, Dr Chang is an individual with vision; in many respects, he has been ahead of the curve, anticipating and leading the direction of paediatric cardiac intensive care.
Collapse
|
89
|
Gaynor JW, Stopp C, Wypij D, Andropoulos DB, Atallah J, Atz AM, Beca J, Donofrio MT, Duncan K, Ghanayem NS, Goldberg CS, Hövels-Gürich H, Ichida F, Jacobs JP, Justo R, Latal B, Li JS, Mahle WT, McQuillen PS, Menon SC, Pemberton VL, Pike NA, Pizarro C, Shekerdemian LS, Synnes A, Williams I, Bellinger DC, Newburger JW. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 2015; 135:816-25. [PMID: 25917996 PMCID: PMC4533222 DOI: 10.1542/peds.2014-3825] [Citation(s) in RCA: 336] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neurodevelopmental disability is the most common complication for survivors of surgery for congenital heart disease (CHD). METHODS We analyzed individual participant data from studies of children evaluated with the Bayley Scales of Infant Development, second edition, after cardiac surgery between 1996 and 2009. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI). RESULTS Among 1770 subjects from 22 institutions, assessed at age 14.5 ± 3.7 months, PDIs and MDIs (77.6 ± 18.8 and 88.2 ± 16.7, respectively) were lower than normative means (each P < .001). Later calendar year of birth was associated with an increased proportion of high-risk infants (complexity of CHD and prevalence of genetic/extracardiac anomalies). After adjustment for center and type of CHD, later year of birth was not significantly associated with better PDI or MDI. Risk factors for lower PDI were lower birth weight, white race, and presence of a genetic/extracardiac anomaly (all P ≤ .01). After adjustment for these factors, PDIs improved over time (0.39 points/year, 95% confidence interval 0.01 to 0.78; P = .045). Risk factors for lower MDI were lower birth weight, male gender, less maternal education, and presence of a genetic/extracardiac anomaly (all P < .001). After adjustment for these factors, MDIs improved over time (0.38 points/year, 95% confidence interval 0.05 to 0.71; P = .02). CONCLUSIONS Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved modestly over time, but only after adjustment for innate patient risk factors. As more high-risk CHD infants undergo cardiac surgery and survive, a growing population will require significant societal resources.
Collapse
Affiliation(s)
| | | | - David Wypij
- Boston Children’s Hospital, Boston, Massachusetts
| | | | - Joseph Atallah
- Stollery Children’s Hospital and the Western Canadian Complex Pediatric Therapies Follow-up Program, Edmonton, Alberta, Canada
| | - Andrew M. Atz
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - John Beca
- Starship Children’s Hospital, Auckland, New Zealand
| | - Mary T. Donofrio
- Children’s National Medical Center, Washington, District of Columbia
| | - Kim Duncan
- Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Nancy S. Ghanayem
- Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Jeffrey P. Jacobs
- Johns Hopkins All Children’s Heart Institute, St. Petersburg, Florida
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Nancy A. Pike
- Children’s Hospital Los Angeles, Los Angeles, California
| | | | | | - Anne Synnes
- University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Ismee Williams
- New York-Presbyterian Morgan Stanley Children’s Hospital of New York, New York, New York
| | | | | | | |
Collapse
|