Assessing Neonatal Visual Maturity in Neonates with Congenital Heart Disease – A Feasibility Study

Abstract

Background: Early detection of adverse neurodevelopmental outcome in neonates with congenital heart disease (CHD) is crucial but challenging. The assessment of neonatal visual maturity is a promising predictor of short-term neurodevelopment. Aims: To assess the feasibility of applying a neonatal visual assessment in CHD neonates and test the predictive value for later neurodevelopment. Study design and subjects: Neonates with CHD underwent a standardized visual assessment before and after surgery or catheter intervention. The 9-item battery was rated by scoring each item outside the 90th centile of a reference population as abnormal (score 1) with higher scores (0-9) indicating worse visual maturity. Total scores were compared between CHD and controls. Neurodevelopment was assessed at 12 months with the Bayley Scales of Infant and Toddler Development. The predictive value of the visual assessment for unfavorable neurodevelopment was assessed with a receiver operating characteristics curve. Results: Twenty-seven neonates with CHD and 25 controls were enrolled. Preoperative assessment was obtained in 5 and postoperative in 24 CHD infants. Only postoperative visual assessment scores were considered for further analysis. Median (IQR) age at postoperative assessment was 27.0 [21.5, 42.0] days of life in CHD infants and 24.0 [15.0, 32.0] in controls. Proportion of abnormal postoperative visual maturity was 12.5% in postoperative CHD infants versus 9.5% in controls (p=1.0). There was no predictive value for unfavorable neurodevelopmental outcome. Conclusion: Preoperative visual assessment of CHD infants is limited while postoperative assessment is feasible. The postoperative visual maturity was similar to controls and not predictive for later neurodevelopment. Funding Information: The study was supported by the Maxi Foundation and the Anna Mueller Grocholski Foundation in Zurich. Declaration of Interests: None. Ethics Approval Statement: Parental written informed consent was obtained, and the study was approved by the ethical committee of the Kanton Zurich, Switzerland. The study was carried out in accordance with the principles enunciated in the Declaration of Helsinki and the guidelines of Good Clinical Practice.