ABSTRACT
Objective: To assess neurodevelopmental status in Indian infantsundergoing corrective surgery for congenital heart disease (CHD)and to analyze factors associated with neurodevelopmental delay.Design : Cross-sectional study.Setting: Tertiary-care pediatric cardiology facility.Participants: Consecutive infants undergoing corrective surgeryfor CHD (January 2013 –December 2014). Palliative procedures,and patients with known genetic syndromes were excluded.Main outcome measures: Neurodevelopmental evaluation 3months, and one year after surgery using DevelopmentalAssessment Scales for Indian Infants (DASII); scores werecategorized as delayed if ?70.Results: Of the 162 children enrolled, delayed PDI and MDIscores were observed in 33.5% and 19.6% of patients at 3months, respectively; this reduced to 14.5 % on 1-year follow-up.On multivariate analysis, delayed PDI outcome at one year waspredicted by early term birth and one-year postoperative headcircumference Z-score <–2. Delayed MDI was associated withhigher mean perfusion pressure on cardiopulmonary bypass.Cardiac diagnosis and peri-operative factors did not impactneurodevelopmental outcomes.Conclusions: Neurodevelopmental status is delayed in 14.5% ofinfants one year after corrective infant heart surgery
ABSTRACT
Objective: To report short-term outcomes of infants with prenatally diagnosed Congenital Heart Disease (CHD) delivered in a tertiary-care cardiac facility. Design: Retrospective study. Setting: Tertiary-care referral hospital. Participants: Children with prenatally diagnosed CHDs who underwent delivery at study centre during the period January 2008 - December 2013 were included. Outcomes tracked from hospital records and direct follow-up. Results: Of the 552 fetuses diagnosed to have CHD, 121 (22%) were delivered at the study centre. Fetuses undergoing a planned delivery were diagnosed in late gestation (mean gestational age 31.5 + 5.1 wk). 74 fetuses (61.2%) had simple CHD and rest were complex. 96 (79.3%) neonates received cardiac care; 30 (24.8%) required surgery while 5 received catheter-based interventions. 11 patients underwent surgery on follow-up. Neonatal survival in cardiac care group was 93.8%; on follow-up (12.5 + 13.1 mo); 83 (86.4%) of these infants were alive. All infants undergoing neonatal surgery or catheter-based interventions survived. 25 patients (20.6%) received comfort care (Complex CHD, associated co-morbidities); 14 (56%) survived neonatal period and 6 (24%) were alive on follow-up. Conclusions: Infants with prenatal diagnosis of CHD and planned delivery in a cardiac facility had satisfactory immediate outcomes, expecially in those receiving specialized post-natal cardiac care.