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In children born with severe heart defect, surgical management has little effect on neuro outcomes
Date:4/5/2012

unt group would fare better in neurodevelopmental tests, reasoning that cerebral blood flow was improved compared to that provided by the Blalock-Taussig shunt. However, neurodevelopmental delay remained common in both groups, a finding that was "discouragingly similar" to results from earlier studies, said J. William Gaynor, M.D., pediatric cardiothoracic surgeon at The Children's Hospital of Philadelphia and senior author of the study. Factors such as the presence of genetic syndromes, lower maternal education and lower birth weight led to lower development scores.

The current study included infants from 15 participating centers, recruited between May 2005 and July 2008. The researchers evaluated 321 infants at 14 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant Development Second Edition, a standardized assessment of cognitive and motor development, with two scores: the Psychomotor Development Index (PDI) and the Mental Development Index (MDI).

MDI scores for the infants who had the Norwood procedure were significantly lower than in the general population, and PDI scores for the cohort were profoundly lowergreater than 2 standard deviations lower in 44 percent of the patients. Infants with both shunt types had similar developmental scores. No characteristics such as center volume or surgeon volume had an effect on PDI or MDI scores, nor did the type of perfusion. The subgroup of patients with the highest PDI and MDI scores, as well as a shorter post-operative hospital stay, were children with no genetic syndrome and birth weights higher than 2.5 kg (5.5 lbs.).

The authors suggested that birth weight might be improved by postponing the time of elective delivery to 39 to 40 weeks. Recent studies have shown that babies with critical congenital heart disease were delivered electively as early as 37 weeks.

The study team found that infants with more post-operative complications tended to have worse
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Contact: Joey McCool Ryan
McCool@email.chop.edu
267-426-6070
Children's Hospital of Philadelphia
Source:Eurekalert

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