Advertisement

Pediatric Cardiology

, Volume 40, Issue 8, pp 1591–1598 | Cite as

Early Neurodevelopmental Outcomes in Children with Hypoplastic Left Heart Syndrome and Related Anomalies After Hybrid Procedure

  • O. M. KhalidEmail author
  • T. M. Harrison
Original Article

Abstract

The hybrid strategy is one approach to single ventricle palliation. In this study, we reported neurodevelopment at 12 months for two cohorts of children managed with the hybrid and clinical factors associated with neurodevelopment in the entire sample. We performed a retrospective study of children with single ventricle who had undergone a neonatal hybrid procedure. One group included infants with hypoplastic left heart syndrome (HLHS); another group included infants with non-HLHS single ventricle. Neurodevelopment was assessed with 12-month Bayley III. Parametric and non-parametric statistics were used for analysis. Nine infants with HLHS and 15 with non-HLHS were identified. Abnormal neurodevelopment was identified in 11 of 24 (46%), primarily motor (46%). Development did not differ between groups. In the whole sample, higher lactate levels were associated with lower cognitive scores (p = 0.04). Fewer mechanical ventilation days were associated with higher cognitive scores (p = 0.05) after Stage 1 and higher motor scores after Stage 2. Shorter ICU length of stay (p = 0.01), shorter hospital length of stay (p = 0.01), and fewer complications (p = 0.01) after stage 2 were associated with higher motor scores. Higher cognitive (p = 0.02) and language (p = 0.002) scores were associated with higher weight at 12 months. In the largest cohort of single ventricle children treated with neonatal hybrid palliation yet reported, significant neurodevelopmental impairment was identified. No differences in neurodevelopment were found between children with HLHS and those with non-HLHS variants. A multicenter trial is needed to test differences in neurodevelopment between hybrid and Norwood approaches.

Keywords

Congenital heart disease Hypoplastic left heart syndrome Neurodevelopmental outcome Hybrid procedure 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Sarajuuri A, Lonnqvist T, Mildh L, Rajantie I, Eronen M, Mattila I, Jokinen E (2009) Prospective follow-up study of children with univentricular heart: neurodevelopmental outcome at age 12 months. J Thorac Cardiovasc Surg 137 (1):139–145, 145.e131–132. doi:10.1016/j.jtcvs.2008.06.025CrossRefGoogle Scholar
  2. 2.
    Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD, Ghanayem NS, Frisbee SJ, Litwin SB (2002) Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 106(12 Suppl 1):I82–89PubMedGoogle Scholar
  3. 3.
    Wypij D, Newburger JW, Rappaport LA, duPlessis AJ, Jonas RA, Wernovsky G, Lin M, Bellinger DC (2003) The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 126(5):1397–1403.  https://doi.org/10.1016/S0022 CrossRefPubMedGoogle Scholar
  4. 4.
    Bayley N (2006) Bayley Scales of Infant and Toddler Development-Third Edition. Harcourt Assessment Inc, San AntonioGoogle Scholar
  5. 5.
    Johnson S, Moore T, Marlow N (2014) Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used? Pediatr Res 75(5):670–674.  https://doi.org/10.1038/pr.2014.10 CrossRefPubMedGoogle Scholar
  6. 6.
    Newburger JW, Sleeper LA, Bellinger DC, Goldberg CS, Tabbutt S, Lu M, Mussatto KA, Williams IA, Gustafson KE, Mital S, Pike N, Sood E, Mahle WT, Cooper DS, Dunbar-Masterson C, Krawczeski CD, Lewis A, Menon SC, Pemberton VL, Ravishankar C, Atz TW, Ohye RG, Gaynor JW, Pediatric Heart Network I (2012) Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation 125(17):2081–2091.  https://doi.org/10.1161/CIRCULATIONAHA.111.064113 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Tabbutt S, Nord AS, Jarvik GP, Bernbaum J, Wernovsky G, Gerdes M, Zackai E, Clancy RR, Nicolson SC, Spray TL, Gaynor JW (2008) Neurodevelopmental outcomes after staged palliation for hypoplastic left heart syndrome. Pediatrics 121(3):476–483.  https://doi.org/10.1542/peds.2007-1282 CrossRefPubMedGoogle Scholar
  8. 8.
    Mahle WT, Lu M, Ohye RG, William Gaynor J, Goldberg CS, Sleeper LA, Pemberton VL, Mussatto KA, Williams IA, Sood E, Krawczeski CD, Lewis A, Mirarchi N, Scheurer M, Pasquali SK, Pinto N, Jacobs JP, McCrindle BW, Newburger JW (2013) A predictive model for neurodevelopmental outcome after the Norwood procedure. Pediatr Cardiol 34(2):327–333.  https://doi.org/10.1007/s00246-012-0450-1 CrossRefPubMedGoogle Scholar
  9. 9.
    Gaynor JW, Gerdes M, Nord AS, Bernbaum J, Zackai E, Wernovsky G, Clancy RR, Heagerty PJ, Solot CB, McDonald-McGinn D, Jarvik GP (2010) Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy? J Thorac Cardiovasc Surg 140(6):1230–1237.  https://doi.org/10.1016/j.jtcvs.2010.07.069 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Goldberg CS, Schwartz EM, Brunberg JA, Mosca RS, Bove EL, Schork MA, Stetz SP, Cheatham JP, Kulik TJ (2000) Neurodevelopmental outcome of patients after the fontan operation: a comparison between children with hypoplastic left heart syndrome and other functional single ventricle lesions. J Pediatr 137(5):646–652.  https://doi.org/10.1067/mpd.2000.108952 CrossRefPubMedGoogle Scholar
  11. 11.
    Martin BJ, De Villiers Jonker I, Joffe AR, Bond GY, Acton BV, Ross DB, Robertson CMT, Rebeyka IM, Atallah J (2017) Hypoplastic left heart syndrome is not associated with worse clinical or neurodevelopmental outcomes than other cardiac pathologies after the Norwood-Sano operation. Pediatr Cardiol 38(5):922–931.  https://doi.org/10.1007/s00246-017-1598-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Knirsch W, Liamlahi R, Hug MI, Hoop R, von Rhein M, Pretre R, Kretschmar O, Latal B (2012) Mortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures. Eur J Cardiothorac Surg 42(1):33–39.  https://doi.org/10.1093/ejcts/ezr286 CrossRefPubMedGoogle Scholar
  13. 13.
    Snookes SH, Gunn JK, Eldridge BJ, Donath SM, Hunt RW, Galea MP, Shekerdemian L (2010) A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 125(4):e818–827.  https://doi.org/10.1542/peds.2009-1959 CrossRefPubMedGoogle Scholar
  14. 14.
    Ravishankar C, Zak V, Williams IA, Bellinger DC, Gaynor JW, Ghanayem NS, Krawczeski CD, Licht DJ, Mahony L, Newburger JW, Pemberton VL, Williams RV, Sananes R, Cook AL, Atz T, Khaikin S, Hsu DT, Pediatric Heart Network I (2013) Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology: a report from the pediatric heart network infant single ventricle trial. J Pediatr 162(2):250–256.e252.  https://doi.org/10.1016/j.jpeds.2012.07.048 (discussion 536−527)CrossRefPubMedGoogle Scholar
  15. 15.
    Acton BV, Biggs WS, Creighton DE, Penner KA, Switzer HN, Thomas JH, Joffe AR, Robertson CM (2011) Overestimating neurodevelopment using the Bayley-III after early complex cardiac surgery. Pediatrics 128(4):e794–e800.  https://doi.org/10.1542/peds.2011-0331 CrossRefPubMedGoogle Scholar
  16. 16.
    Andropoulos DB, Ahmad HB, Haq T, Brady K, Stayer SA, Meador MR, Hunter JV, Rivera C, Voigt RG, Turcich M, He CQ, Shekerdemian LS, Dickerson HA, Fraser CD, Dean McKenzie E, Heinle JS, Blaine Easley R (2014) The association between brain injury, perioperative anesthetic exposure, and 12-month neurodevelopmental outcomes after neonatal cardiac surgery: a retrospective cohort study. Paediatr Anaesth 24(3):266–274.  https://doi.org/10.1111/pan.12350 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Heart Center, Nationwide Children’s HospitalColumbusUSA
  2. 2.The Ohio State University College of NursingColumbusUSA

Personalised recommendations