Introduction: Infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks of gestation and received neonatal open cardiac surgery (OHS) have poorer neurodevelopmental outcomes in early childhood, when compared with those born at term gestation. Specific details related to the neurodevelopmental outcome of these infants remain unpublished. We aimed 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.
Methods: Between 1996 and 2016, we studied all infants with CCHD who received OHS within 6 weeks corrected age in the Western Canadian Complex Pediatric Therapies Follow-up Program. Comprehensive neurodevelopmental assessments at 18-24 months corrected age 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: During the period, 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; 18(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, 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.
Morteza Hajihosseini– Gradaute stiudent, University of Alberta
Irina Dinu– Associate Professor, University of Alberta
Heather Switzer– Clinical Child Psychologist, Prairie Psychology Services
Charlene Robertson– Emeritus Professor, Uniersity of Alberta