Younger gestational age is associated with worse neurodevelopmental outcomes after cardiac surgery in infancy

Abstract Purpose This retrospective cohort study aimed to investigate the surgical and neurodevelopmental outcomes (NDO) of infant hydrocephalus. We also sought to determine whether these outcomes are disproportionately poorer in post-haemorrhagic hydrocephalus (PHH) compared to other causes of infant hydrocephalus. Methods A review of all infants with hydrocephalus who had ventriculoperitoneal (VP) shunts inserted at Great Ormond Street Hospital (GOSH) from 2008 to 2018 was performed. Demographic, surgical, neurodevelopmental, and other clinical data extracted from electronic patient notes were analysed by aetiology. Shunt survival, NDO, cerebral palsy (CP), epilepsy, speech delay, education, behavioural disorders, endocrine dysfunction, and mortality were evaluated. Results A total of 323 infants with median gestational age of 37.0 (23.29–42.14) weeks and birthweight of 2640 g (525–4684 g) were evaluated. PHH was the most common aetiology (31.9%) and was associated with significantly higher 5-year shunt revision rates, revisions beyond a year, and median number of revisions than congenital or “other” hydrocephalus (all p < 0.02). Cox regression demonstrated poorest shunt survival in PHH, related to gestational age at birth and corrected age at shunt insertion. PHH also had the highest rate of severe disabilities, increasing with age to 65.0% at 10 years, as well as the highest CP rate; only genetic hydrocephalus had significantly higher endocrine dysfunction (p = 0.01) and mortality rates (p = 0.04). Conclusions Infants with PHH have poorer surgical and NDO compared to all other aetiologies, except genetic hydrocephalus. Research into measures of reducing neurodisability following PHH is urgently required. Long-term follow-up is essential to optimise support and outcomes.

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Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

Scientific Reports ◽

10.1038/s41598-021-86292-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoo Jinie Kim ◽

Seung Han Shin ◽

Eun Sun Lee ◽

Young Hwa Jung ◽

Young Ah Lee ◽

...

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Growth Velocity ◽

Postnatal Growth ◽

School Age ◽

Z Score ◽

Neurodevelopmental Outcomes ◽

Neurocognitive Outcomes ◽

Size At Birth

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

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Neurodevelopmental outcomes of singleton large for gestational age infants <29 weeks’ gestation: a retrospective cohort study

Journal of Perinatology ◽

10.1038/s41372-021-01080-z ◽

2021 ◽

Author(s):

Deepika Rustogi ◽

◽

Anne Synnes ◽

Belal Alshaikh ◽

Shabih Hasan ◽

...

Keyword(s):

Cohort Study ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Large For Gestational Age ◽

Neurodevelopmental Outcomes

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Two-year neurodevelopmental outcomes of infants undergoing neonatal cardiac surgery for interrupted aortic arch: A descriptive analysis

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2009.03.016 ◽

2009 ◽

Vol 138 (4) ◽

pp. 924-932 ◽

Cited By ~ 10

Author(s):

Chloe A. Joynt ◽

Charlene M.T. Robertson ◽

Po-Yin Cheung ◽

Alberto Nettel-Aguirre ◽

Ari R. Joffe ◽

...

Keyword(s):

Cardiac Surgery ◽

Aortic Arch ◽

Descriptive Analysis ◽

Interrupted Aortic Arch ◽

Neurodevelopmental Outcomes ◽

Neonatal Cardiac Surgery

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Gestational Age at Birth and Outcomes After Neonatal Cardiac Surgery

Circulation ◽

10.1161/circulationaha.113.005864 ◽

2014 ◽

Vol 129 (24) ◽

pp. 2511-2517 ◽

Cited By ~ 74

Author(s):

John M. Costello ◽

Sara K. Pasquali ◽

Jeffrey P. Jacobs ◽

Xia He ◽

Kevin D. Hill ◽

...

Keyword(s):

Cardiac Surgery ◽

Gestational Age ◽

Neonatal Cardiac Surgery ◽

Gestational Age At Birth ◽

Age At Birth

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Abstract 17071: Growth Asymmetry, Head Circumference and Neurodevelopmental Outcomes in Infants with Single Ventricles

Circulation ◽

10.1161/circ.130.suppl_2.17071 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Thomas A Miller ◽

Victor Zak ◽

Peter Shrader ◽

Chitra Ravishankar ◽

Victoria L Pemberton ◽

...

Keyword(s):

Gestational Age ◽

Head Circumference ◽

Single Ventricle ◽

Univariate Analysis ◽

Somatic Growth ◽

Z Score ◽

Neurodevelopmental Outcomes ◽

Head Growth ◽

Developmental Index ◽

Asymmetric Growth

Poor somatic growth is common in infants with single ventricle (SV) physiology and has been linked to increased morbidity and impaired neurodevelopment. Asymmetry in somatic growth, a potential brain-sparing adaptation, is important in predicting outcomes in premature and small for gestational age (SGA) infants. Objectives: To assess variability in growth asymmetry and its associations with neurodevelopment in infants with SV. Methods: We analyzed growth asymmetry (weight for age z-score (WAZ) minus head circumference for age z-score (HCAZ)), relative head growth (change in cm/change in kg), HCAZ, and change in HCAZ from baseline to pre-Glenn in subjects prospectively enrolled in the Pediatric Heart Network Infant Single Ventricle (ISV) trial. Associations between these indices and results of the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID) at 14 months were assessed. Results: Of the 230 patients enrolled in ISV, complete biometric data and BSID results were available in 168 (73%). For this cohort, age at enrollment was 21±9 days, age at pre-Glenn was 167±52 days, gestational age was 38.3±1.4 weeks, and 71% were male. Growth asymmetry varied across the cohort at enrollment (0.43 ±1.02, range -2.85 to 4.84) and the pre-Glenn visit (-0.23 ±1.21, range -4.45 to 3.00) as did the relative head growth (2.40±0.86, range 0.50 to 8.00). BSID scores were not associated with indices of growth asymmetry. In univariate analysis, larger pre-Glenn HCAZ correlated with higher MDI (r=0.21, p=0.006) and PDI (r=0.38, p<0.001) and greater increase in HCAZ from enrollment to pre-Glenn was associated with higher PDI (r=0.15, p=0.049). In multivariable modeling adjusting for site, serious adverse events, stage 1 length of stay, and height at 14 months, pre-Glenn HCAZ was an independent predictor of PDI (p=0.03), but not MDI. For each one unit Z-score increase in pre-Glenn HCAZ, the predicted PDI score increased by 2.5 points. Conclusions: In infants with SV, BSID scores were associated with pre-Glenn HCAZ but not with the degree of asymmetric growth. Future studies should explore why asymmetric growth that seems important in premature and SGA infants appears less relevant in infants with SV.

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553 NEURODEVELOPMENTAL OUTCOMES OF PRETERM SMALL FOR GESTATIONAL AGE INFANTS BORN TO MOTHERS WITH AND WITHOUT PREECLAMPSIA.

Journal of Investigative Medicine ◽

10.2310/6650.2005.x0004.552 ◽

2006 ◽

Vol 54 (1) ◽

pp. S174.2-S174

Author(s):

E. E. Rogers ◽

C. Leonard ◽

R. Piecuch

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Neurodevelopmental Outcomes

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Association of intraoperative circulating-brain injury biomarker and neurodevelopmental outcomes at 1 year among neonates who have undergone cardiac surgery

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.01.040 ◽

2019 ◽

Vol 157 (5) ◽

pp. 1996-2002 ◽

Cited By ~ 6

Author(s):

Eric M. Graham ◽

Renee' H. Martin ◽

Andrew M. Atz ◽

Kasey Hamlin-Smith ◽

Minoo N. Kavarana ◽

...

Keyword(s):

Cardiac Surgery ◽

Brain Injury ◽

Neurodevelopmental Outcomes

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37 Growth and neurodevelopment in early childhood of preterm infants with complex congenital heart defects following open cardiac surgery

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.036 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e14-e15

Author(s):

Po-Yin Cheung ◽

Morteza Hajihosseini ◽

Irina Dinu ◽

Heather Switzer ◽

Charlene M T Robertson

Keyword(s):

Early Childhood ◽

Hearing Loss ◽

Cardiac Surgery ◽

Cerebral Palsy ◽

Preterm Infants ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Neurodevelopmental Outcome ◽

Neurodevelopmental Outcomes

Abstract Background Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestational age and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. Specific details related to the neurodevelopmental outcome of these infants remain unpublished. Objectives To describe the growth, disability, functional, and neurodevelopmental outcome in early childhood of preterm infants (born at <37+0 weeks gestation) with CCHD and neonatal OHS. Design/Methods We studied all infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. In the Western Canadian Complex Pediatric Therapies Follow-up Program, comprehensive neurodevelopmental assessments at a corrected age of 18-24 months were done by multidisciplinary teams at the original referral sites. In addition to demographic and clinical data, standardized age-appropriate outcome measures included physical growth with calculated Z-scores, disabilities including cerebral palsy, visual impairment, sensorineural hearing loss; adaptive function (Adaptive Behavioural Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Results From 1996 to 2016, 115 preterm infants (34±2 weeks gestation, 2339±637g, 64% males) with CCHD had OHS with 11(10%) deaths before first discharge and 21 (18%) by 2 years. Prior to the first surgery, 7 (6%) neonates had cerebral injuries. Overall, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. All 94 surviving infants received comprehensive evaluation at 2 years corrected age; Eighteen (19%) had congenital syndromes who had worse functional and neurodevelopmental outcomes compared to those (n=76) without syndromal abnormalities (SA) (Table). Conclusion For preterm neonates with CCHD and early OHS, the mortality was significant, but the short-term neonatal morbidity was not increased. Compared with published preterm outcomes, the early outcome suggests more cerebral palsy but not sensorineural hearing loss, and greater neurodevelopmental delay. This information is important for management care of the infants, parental counselling and the decision-making process.

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