Neurodevelopmental Follow-up Research Articles

Breastfeeding peer counselling for mothers of preterm neonates: protocol of a stepped-wedge cluster randomised controlled trial

IntroductionAmong preterm infants, mother’s own milk feeding reduces neonatal morbidity and decreases the length of hospital stay. However, breastfeeding rates and duration are lower than among term infants. It is...

Neonatal Intestinal Failure Is Independently Associated With Impaired Cognitive Development Later in Childhood

The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. Patients with IF with >60 days of parental nutrition (PN) dependency aged between 3 and 16 years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wechsler Intelligence Scale for Children, 4th edition, and Movement Assessment Battery for Children, 2nd edition. All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age, and birth weight was 7.5 (range 3-16) years, 35 (interquartile range [IQR] 28-38) weeks and 2238 (IQR 1040-3288) grams, respectively. Median duration of PN was 13 (IQR 5-37) months and 9 patients were currently on PN. Median intelligence quotient was 78 (IQR 65-91) and 10 (35%) patients had an intelligence quotient under 70 (-2 standard deviation). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, whereas adverse motor outcome was associated with prematurity. Clinically significant cognitive and motor impairments are alarmingly common among neonatal patients with IF. We recommend early neurodevelopmental follow-up for all children with IF.

Impact of multiple placental pathologies on neonatal death, bronchopulmonary dysplasia, and neurodevelopmental impairment in preterm infants.

BackgroundTo determine the association of placental pathology, including multiple placental lesions, with the occurrence and severity of bronchopulmonary dysplasia (BPD), death, and neurodevelopmental impairment (NDI) in preterm infants.MethodA retrospective cohort study of neonates <29 weeks gestational age (GA) born at Parkland Hospital from 08/2009 to 08/2012. Infants were stratified as follows: Group 1: no significant placental pathology; Group 2: single significant placental lesion; and Group 3: ≥2 placental lesions (multiple lesions). Primary outcome was death and/or BPD. Two-year neurodevelopmental follow-up was compared.ResultsIn all, 42% (100/241) of infants had one placental lesion, and 34% (82/241) ≥2 lesions. As the number of the pathologic lesions increased (no lesions vs. 1 vs. ≥2), the occurrence of death or BPD increased (25%, 37%, and 52%, respectively; P = 0.004). Moreover, infants with multiple pathologic lesions were more likely to have NDI (29%, 29%, and 46%, respectively; P = 0.03). After logistic regression, infants with multiple pathologic lesions were more likely to develop moderate-to-severe BPD [P < 0.01; OR 3.9 (1.5–10.1)] but not NDI.Conclusion(s)Neonates <29 weeks GA with multiple placental pathologic lesions have an increased risk for developing BPD, suggesting an interaction between placental inflammation and vascular pathology and the pathogenesis of BPD; however, the risk of NDI is not increased.

Cerebral Palsy in Children With Congenital Zika Syndrome: A 2-Year Neurodevelopmental Follow-up.

To describe the 2-year neurodevelopmental outcome in children with cerebral palsy associated with congenital Zika (CZ) and explore variables associated with a more severe presentation. Data on 69 children with cerebral palsy associated with CZ, followed in a neurorehabilitation hospital, who consecutively attended the neurodevelopmental assessment at 2 years of age, were collected. Bayley III Scales of Infant and Toddler Development, Hammersmith Infant Neurological Examination, and Gross Motor Function Classification System were used for the outcome evaluation. Descriptive and inferential statistical analysis were performed. The median age at follow-up was of 24.0 (23-32) months. Only 3 (4.3%) children were not microcephalic. The majority presented with bilateral (94.2%), spastic (100.0%), Gross Motor Function Classification System grade IV or V (92.8%) cerebral palsy, epilepsy (73.1%), extremely low performances on cognitive (94.2%), language (95.7%), and motor (95.7%) Bayley-III Scales of Infant and Toddler Development Test scores. The median Hammersmith Infant Neurological Examination score was of 21.0 (range 9-75). There was a correlation between birth head circumference with the cognitive (r = 0.3, P < .01), language (r = 0.3, P < .01), and motor (r = 0.3, P < .01) Bayley-III Scales of Infant and Toddler Development Test scores, as well as with the Hammersmith Infant Neurological Examination score (r = 0.2, P < .03). An association was observed between an inferior median Hammersmith Infant Neurological Examination score with congenital microcephaly (P = .04), arthrogryposis (P = .02), and epilepsy in the first year (P < .01). Cerebral palsy related to CZ presents with a severe global impairment at a 2-year follow-up. Birth head circumference, arthrogryposis, and early epilepsy are associated with a worse outcome and may be considered as prognostic markers. These findings are important for the neurorehabilitation planning, parents' guiding, and future prognostic studies.

1872. Neurodevelopment in Apparently Normal Infants from Zika Virus Positive Pregnancies

BackgroundCongenital Zika syndrome (CZS) is seen in 5–12% of newborns from Zika virus (ZIKV)-infected pregnancies and includes severe neurologic abnormalities. However, the majority of ZIKV-exposed newborns do not have CZS. The risk for neurodevelopmental impairment for infants without CZS following in utero ZIKV is not well known. The objective was to determine whether infants without CZS exposed to ZIKV in utero, have normal neurodevelopment.MethodsWe performed a longitudinal study of neurodevelopment in Colombia for infants exposed to ZIKV in utero who had a normal fetal brain MRI (Mulkey et al, JAMA Peds 2019) and normal head circumference at birth. Infant development was assessed by the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA) and the Alberta Infant Motor Scale (AIMS) between 6 and 18 months of age. In-person training was done by a neurologist. The AIMS were video-recorded and scored centrally. Interrater reliability for the novel method of video-based AIMS was determined. WIDEA and AIMS scores were converted to Z-scores compared with normative samples. We also compared development between infants with normal and nonspecific findings on cranial ultrasound (US).ResultsSeventy-two non-CZS infants had neurodevelopmental tests; 40 were at a mean (SD) of 5.7 (0.9) months and 66 were at 13.5 (3.2) months of age. Thirty-four had two assessments. The total WIDEA, social cognition, and mobility domain scores became more abnormal with postnatal age (figure). The AIMS scores were similar to the normative sample. Three infants had an AIMS score < 2 SD’s below the norm. On cranial US, 19 infants (26%) had a nonspecific finding (lenticulostriate vasculopathy, choroid plexus cysts, subependymal cysts, and/or calcification). Infants with a US finding had a lower WIDEA mobility score than infants with normal US (P = .054). There was a trend toward lower AIMS scores in infants with US findings compared with infants with normal US (P = .26). AIMS Interrater agreement on video-based scoring was good (ICC = 0.73, 95% CI 0.42, 0.87).ConclusionZIKV-exposed infants without CZS are at risk for neurodevelopmental delay. Nonspecific cranial US findings may represent mild ZIKV-related injury. Long-term neurodevelopmental follow-up is important for all ZIKV-exposed infants. Disclosures All Authors: No reported Disclosures.

Outcome of vein of Galen malformation presenting in the neonatal period

ObjectiveVein of Galenaneurysmal malformation (VGAM) is a rare but important congenital malformation presenting to neonatal intensive care units (NICUs), and with a change from surgical to endovascular management, survival for...

White Matter Injury and Structural Anomalies in Infants with Prenatal Opioid Exposue

Previous studies have not found structural injury or brain malformations in infants and children with prenatal opioid exposure. As part of an ongoing study evaluating neuroimaging in infants with prenatal opioid exposure, we reviewed structural brain MR imaging in 20 term infants with prenatal opioid exposure and 20 term controls at 4-8 weeks of age. We found that 8 of the 20 opioid-exposed infants had punctate white matter lesions or white matter signal abnormality on structural MR imaging, and 2 of the opioid-exposed infants had a septopreoptic fusion anomaly. No controls had white matter injury or structural malformations. Our findings underscore the importance of clinical neurodevelopmental follow-up and the need for more comprehensive imaging and long-term outcomes research following prenatal opioid exposure.

Neurobehavioral outcomes in patients with myelomeningocele.

This paper describes some of the more common patterns in neurobehavioral deficits and their underlying neuroanatomical basis in myelomeningocele (MMC). Patients with MMC can face a lifetime of specific organ system dysfunction, chief among them spinal cord malformations, orthopedic issues, hydrocephalus, and urological disabilities. In addition, patients can experience specific patterns of neurobehavioral difficulties due to the changes in neuroanatomy associated with the open spinal defect. Although there is variability in these patterns, some trends have been described among MMC patients. It is thought that early recognition of these potential neurobehavioral deficits by treating neurosurgeons and other members of the treatment team could lead to earlier intervention and positively impact the overall outcome for patients. Neurodevelopmental and neurobehavioral follow-up assessments are recommended to help guide planning for relevant treatments or accommodations.

Neurodevelopmental outcomes of children with congenital heart disease: A review

Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.

Epilepsy occurrence after neonatal morbidities in very preterm infants.

This study investigated the incidence of epilepsy and identified neonatal risk morbidities for epilepsy in children born extremely preterm. Of the 806 very preterm infants (birth weight<1500g, gestational age<32weeks) who survived and were discharged from the four neonatal intensive care units in southern Taiwan between 2003 and 2012, 686 (85.1%) had longitudinal neurodevelopmental follow-up assessments up to 5years of age. Among the 686 very preterm children, 19 (2.8%) exhibited epilepsy at a mean age of 19±14months. The incidence of epilepsy was highest among infants with neonatal seizure (33%), followed by cystic periventricular leukomalacia (cPVL, 27%), high-grade intraventricular hemorrhage (IVH, 21%), and necrotizing enterocolitis (NEC) stage III (20%). NEC stage III, neonatal seizure, high-grade IVH, and cPVL were also independent neonatal risk morbidities for epilepsy. Furthermore, the incidence of epilepsy was 21.6% in preterm children with significant neonatal brain injury (SNBI; ie, high-grade IVH and cPVL), but only 1% in preterm children without SNBI. Among preterm children with SNBI, neonatal seizure was higher in preterm children with epilepsy than in those without epilepsy (23.1% vs 2.1%, P=.03). Among preterm children without SNBI, NEC stage III was higher in preterm children with epilepsy than in those without epilepsy (33.3% vs 1.8%, P<.01). The preterm children with epilepsy were prone to have neurodevelopmental disability regardless of whether they had neonatal brain injury, and drug-resistant epilepsy (42%), particularly those with neonatal high-grade IVH. There is an elevated incidence of epilepsy among very preterm children, and particularly those with significant brain injury and/or severe NEC during the neonatal period. Very preterm children with epilepsy are prone to have neurodevelopmental disability and drug-resistant epilepsy.

Association between fat-soluble nutrient status and auditory and visual related potentials in newly diagnosed non-screened infants with cystic fibrosis: A case-control study

Nutritional deficiencies often precede the diagnosis of cystic fibrosis (CF) in infants, and occur at a stage where the rapidly developing brain is more vulnerable to insult.We aim to compare fat-soluble nutrient status of newly diagnosed non-screened infants with CF to that of healthy infants, and explore the association with neurodevelopment evaluated by electroencephalography (EEG).Our results show that CF infants had lower levels of all fat-soluble vitamins and docosahexaenoic acid (DHA) compared to controls. The auditory evoked potential responses were higher in CF compared to controls whereas the visual components did not differ between groups. DHA levels were correlated with auditory evoked potential responses. Although resting state frequency power was similar between groups, we observed a negative correlation between DHA levels and low frequencies. This study emphasizes the need for long-term neurodevelopmental follow-up of CF infants and pursuing intervention strategies in the future.

Neonatal neuroimaging after repair of congenital diaphragmatic hernia and long-term neurodevelopmental outcome

ObjectivePrevious outcome reports of congenital diaphragmatic hernia (CDH) have described neuroimaging anomalies and neurodevelopmental impairment. However, the link between imaging and outcome has not been described. We aimed to determine...

C-58 Reliable Change Index to Monitor Executive, Adaptive and Behavioral Functioning in Children with Perinatal Complications

Abstract Objective Research demonstrates that children with perinatal complications (i.e., extreme prematurity, hemorrhage, hypoxic-ischemic injury) are at increased-risk for behavior, executive functioning, and adaptive independence problems in their everyday life. The purpose of this study is to demonstrate the importance of monitoring for changes in these domains as these children reach school-age. Method The current study reviewed retrospective neuropsychological evaluations for a sample of 8 children (ages 5-10 years) evaluated in an outpatient neurodevelopmental follow-up program for children with perinatal complications. Re-evaluation was completed 1-2 years later. Children with the following standardized parent-report measures were included: Behavior Assessment System for Children (BASC-2,3), Behavior Rating Inventory of Executive Function (BRIEF, 2), and Adaptive Behavior Assessment System (ABAS-3). A reliable change index was calculated for each child to compare individual change in subscales/indices using gender/age standard error of measurement from test manuals. Results BRIEF subscale RCI values (≥ 1.96) indicated that most children showed increased problems with inhibition, shifting, working memory, and planning/organizational (range -13 to 13), whereas most showed improved emotional control (range -12 to 3). BASC indices revealed stability in behavioral and externalizing symptoms (range -3 to 2). ABAS RCI values indicated that children tended to improve across skills (range -19 to 27). Figures and tables will be displayed. Conclusions This study highlights the utility of RCI values in monitoring neuropsychological changes during the early school years, as this sample of children showed changes across several developing skills. Early identification of behavioral or adaptive deficits allows providers to make recommendations for clinical management and academic planning.

C-57 Prematurity and Perinatal Insult: Examining the relationships between parent and teacher ratings of executive functioning and academic readiness

Abstract Objective Extremely preterm children and those with a history of perinatal insult (e.g., hemorrhage, hypoxic-ischemic injury) show higher rates of cognitive and academic problems, including executive functioning (EF). EF becomes increasingly important in elementary school as curriculum demands increase. The current study examines the relationship between parent- and teacher-reported EF and early academic performance in this population at school-age. Method This study reviewed retrospective neuropsychological evaluations in a sample of 135 patients (ages 3:9-10:5 years, M = 5.8) from an outpatient neurodevelopmental follow-up program for children with perinatal complication. Parent and teacher measures included: Behavior Assessment Scale for Children (BASC-2, 3) and Behavioral Rating Inventory of Executive Functioning (BRIEF, P, 2). Standardized child measures included: Bracken School Readiness (BBCS-III), and subtests from Wechsler Individual Achievement Test (WIAT-III) and Comprehensive Test of Phonological Processing (CTOPP-2). Results BRIEF parent ratings of working memory (p = 0.34) and emotional control (p = .025) were negatively correlated with school readiness. BRIEF teacher inhibition and working memory ratings were negatively correlated with math performance (p = .004 to p = .044), as well as rapid naming (p = .002 to p = .047) and school readiness (p = .048). BRIEF teacher ratings of planning/organization (p = .027), shifting (p = .024), and emotional control (p = .010) were negatively correlated with pre-reading measures. A 95% confidence interval was used. Conclusions Parent and teacher ratings of EF were significantly correlated with measures of academic readiness, early math skill, and pre-reading measures in this sample of children with a history of perinatal complications. Caregiver ratings can be useful in identifying children at-risk for academic problems upon school entry and requiring further neuropsychological evaluation.

Does permissive hypercapnia carry increased risk for neurodevelopmental sequelae?

Commentary on: Thome UH, Genzel-Boroviczeny O, Bohnhorst B, for the PHELBI Study Group, et al. Neurodevelopmental outcomes of extremely low birthweight infants randomised to different PCO2 targets: the PHELBI follow-up study. Arch Dis Child Fetal Neonatal Ed 2017; 102: F376–82. PMID: 28087725. Despite advances in ventilatory support, it is not clear what levels of PaCO2 are safe in extremely premature infants. Permissive hypercapnia is a strategy that tolerates higher levels of PaCO2 with the expectation to reduce ventilator-induced lung injury. One potential downside of permissive hypercapnia is the association with intraventricular haemorrhages (IVH) and poor developmental outcomes 1, 2. In the PHELBI trial 3, investigators studied the effects of permissive hypercapnia. Although the study had some limitations 4 and was stopped early due to no reduction in BPD or death, it remains a valuable study, showing that hypercapnia did not increase IVH or retinopathy of prematurity (ROP). Investigators assessed neurodevelopment at two years corrected age on infants who participated in the original trial 4. Follow-up evaluations were performed using German translations of accepted standard of care evaluation methods. Age and growth at the follow-up examinations were similar and not suggestive of confounding effects. Neurodevelopment of infants that participated in follow-up assessment was comparable between PaCO2 target groups. Child's development per CDI questionnaire and cerebral palsy were evenly distributed, as well as rates of hearing or visual impairment. This study is limited as the original trial was not designed for detecting neurodevelopmental differences at two-year follow-up and the trial was stopped early after no evidence of treatment effect. Finally, 15% of infants were lost to follow-up (14% in High Target Group and 15% in Low Target Group) and 10% did not complete all follow-up examinations. Baseline characteristics of patients lost to follow-up and those who completed testing appeared similar; however, it would be beneficial for interpretation to see the characteristics of those who did not complete testing. The authors acknowledge that there is no formal German validation for the BSIDII, though results obtained are similar to American infants. There was no blinding to study arm allocation in the original trial, and masking of individuals involved in the neurodevelopmental follow-up testing is not specified. Conclusions drawn from these data must be considered in light of these limitations. Benefits of permissive hypercapnia, as defined by this trial, were not observed in the study findings. BPD is associated with adverse neurodevelopment 5, and optimal PaCO2 levels remain unclear. Observational studies have found that large fluctuations and higher than average PaCO2 increase risk 3, 6, 7, while a meta-analysis of randomised trials for permissive hypercapnia shows that morbidity and neurodevelopmental outcomes did not differ between PaCO2 target groups 8. The PHELBI trial did not identify the optimal target range of PaCO2, and data suggest that permissive hypercapnia does not grant lung protection in extremely low birthweight infants. One should consider that permissive hypercapnia as a strategy to decrease chronic lung disease is not supported by data from this randomised trial. However, based on the comparable neurologic development observed in the study, clinician angst is not warranted and aggressive ventilator adjustments should not be implemented in order to normalise PaCO2 in extremely premature patients who are otherwise clinically stable. https://ebneo.org/2019/06/permissive-hypercapnia-neurodevelopmental-sequelae There was no funding for this review. The authors have no conflicts of interest to disclose.

Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report

ABSTRACTClozapine is an antipsychotic drug for the treatment-resistant schizophrenia. Although clozapine is superior to other antipsychotics, it is less common in psychiatric prescriptions due to c...

A New Model of Early Intervention Based on The Osteopathic Integrated Approach: Clinical Experience About 530 Newborn

Background: Newborns at risk for developmental impairment need a specific follow-up for early diagnosis and adequate intervention. During the first year of life neural plasticity is at its highest; this is the most appropriate time for an effective intervention, in order to promote healthy relationships and good experiences. Osteopathy is a manual therapy based on the evaluation and soft mobilization of the musculoskeletal and fascial systems in order to improve posture and motor skills. Some studies support its scientific value and safety for children undergoing osteopathic treatments. Materials and Methods: We present clinical data collected during the experience at the program for “Neurodevelopmental Follow-up and Pediatric Osteopathy" at Desenzano del Garda Hospital (Italy). It’s a public health service in which osteopathy has been included in a perspective of Osteopathic Integrated Early Intervention. The program, covering the first years of life, is dedicated to newborns at risk for developmental impairment and consists in:

P02-F Early EEG characteristics in hypoxic-ischemic encephalopathy and outcome at 2 years

EEG is an important tool for early cerebral evaluation in neonatal hypoxo-ischemic encephalopathy (HIE). The aim of our study was to precise the EEG prognosis value before starting hypothermia and during 72 h hypothermia in neurodevelopment evaluation with at least 2 years clinical follow-up. We analyzed 98 newborns admitted for suspicion of HIE. First EEG was done before 6 h of life, it was surveyed continuously and analyzed twice a day during 72 H hypothermia and in 12 h following rewarming. EEG recordings were characterized according to the French classification. The neurologic outcome was assessed at 24 months. Eighty-four infants completed neurodevelopmental follow-up. 18 of newborns died during the neonatal period. Among the survivors, 64%, 21% and 15% had respectively normal, moderate and severe outcomes. The first EEG before hypothermia do not correlated with the neurodevelopmental outcome. On the other hand, The EEG characteristics between 36 and 60 h of life, correlated strongly with the outcome. Normal or mildly abnormal EEG (minor abnormalities or discontinuous tracing type A) after the first 48 h had 95% positive predictive value EEG for normal or moderate impairment at 2 years (negative predictive value 77%, specificity 91%). Severe EEG abnormalities (discontinuous tracing type B, paroxysmal or inactive tracings) within the first 48 h had respectively 96% and 76% negative and positive value for poor outcomes (severe outcome or death) (sensitivity 91% and specificity 89%).

Ancillary referral patterns in infants after initial assessment in a cardiac developmental outcomes clinic.

Neurodevelopmental impairment is common after surgery for congenital heart disease (CHD) in infancy. While neurodevelopmental follow-up of high-risk patients has increased, the referral patterns for ancillary services following initial evaluation have not been reported. The aim of this study is to describe the rates and patterns of referral at the initial visit to our outcomes clinic of patients who underwent surgery for CHD during infancy. The Cardiac Developmental Outcomes Program clinic at Texas Children's Hospital provides routine longitudinal follow-up with developmental pediatricians and child psychologists for children who required surgery for CHD within the first 3 months of life. Demographic, diagnostic, and clinical data, including prior receipt of intervention and referral patterns at initial presentation, were abstracted from our database. Between April 2013 and May 2017, 244 infants under 12 months of age presented for initial evaluation at a mean age of 7 ± 1.3 months. At presentation, 31% (76/244) were referred for either therapeutic intervention (early intervention or private therapies), ancillary medical services, or both. Referral rates for low-risk (STAT 1-3) and high-risk (STAT 4-5) infants were similar (28 vs. 33%, P=.48). Referrals were more common in: Hispanic white infants (P=.012), infants with non-cardiac congenital anomalies (P=.001), history of gastrostomy tube placement (P<.001), and infants with prior therapy (P=.043). Infants of non-English speaking parents were three times more likely to be referred (95% CI=1.5, 6.4; P=.002). At the time of presentation, nearly 1 in 3 infants required referral. Referral patterns did not vary by traditional risk stratification. Sociodemographic factors and co-morbid medical conditions increased the likelihood of referral. This supports the need for routine follow-up for all post-surgical infants regardless of level of surgical complexity. Further research into the completion of referrals and long-term referral patterns is needed.

Early Neurodevelopmental Outcomes in Children Supported with ECMO for Cardiac Indications.

Extracorporeal membrane oxygenation (ECMO) is lifesaving for many critically ill children with congenital heart disease (CHD). However, limited information is available about their ensuing neurodevelopmental (ND) outcomes. We describe early ND outcomes in a cohort of children supported with ECMO for cardiac indications. Twenty-eight patients supported with ECMO at age < 36months underwent later ND testing at 12-42months of age using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). ND scores were compared with normative means and with ND outcomes of a matched cohort of 79 children with CHD undergoing cardiac surgery but not requiring ECMO support. Risk factors for worse ND outcomes were identified using multivariable linear regression models. Cardiac ECMO patients had ND scores at least one standard deviation below the normative mean in the gross motor (61%), language (43%), and cognitive (29%) domains of the Bayley-III. Cardiac ECMO patients had lower scores on the motor, language, and cognitive domains as compared to the matched non-ECMO group and clinically important (1/2 SD) differences in the motor domain persisted after controlling for primary caregiver education and number of cardiac catheterizations. Risk factors of worse ND outcomes among cardiac ECMO patients in more than one developmental domain included older age at first cannulation and more cardiac catheterization and cardiac surgical procedures prior to ND assessment. Overall, children supported on ECMO for cardiac indications have significant developmental delays and warrant close ND follow-up.