Clinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery

Abstract

Our goal was to determine if a clinical outcome score derived from early postoperative events is associated with 18- to 24-month Psychomotor Developmental Index (PDI) score among infants undergoing cardiopulmonary bypass surgery. We included infants aged ≤6 weeks who underwent surgery during 2002-2006, all of whom were referred for neurodevelopmental evaluation at age 18 to 24 months. We excluded children with chromosomal abnormalities, hearing loss, cerebral palsy, or a Bayley III assessment. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal membrane oxygenation were assigned a score of 7. Ninety-nine subjects were included. Surgical procedures were arterial switch (n=36), Norwood (n=26), repair of total anomalous pulmonary venous connection (n=16), and other (n=21). Four subjects had postoperative extracorporeal membrane oxygenation. Clinical outcome scores were highest in the Norwood group (mean 4.1 ± 1.4) compared with the arterial switch group (1.9 ± 1.6) (P<.001), total anomalous pulmonary venous connection group (1.6 ± 2.0) (P<.001), and other group (3.3 ± 1.6, P=not significant). A mean decrease in PDI of 10.9 points (95% confidence interval, 4.9-16.9; P=.0005) was observed among children who had a clinical outcome score ≥3, compared with those with a clinical outcome score <3. Time until lactate ≤2.0 mmol/L increased with increasing clinical outcome score (P=.0003), as did highest 24-hour inotrope score (P<.0001). Clinical outcome scores of ≥3 were associated with a significantly lower PDI at age 18 to 24months. This score may be valuable as an end point when evaluating novel potential therapies for this high-risk population.