Predictors of impaired neurodevelopmental outcomes at one year of age after infant cardiac surgery
Predictors of impaired neurodevelopmental outcomes at one year of age after infant cardiac surgery
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DOI：
10.1016/j.ejcts.2009.02.047
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发表时间：
2009-07-01
影响因子：
3.4
通讯作者：
Gaynor, James William
中科院分区：
文献类型：
--
作者：
Fuller, Stephanie;Nord, Alex S.;Gaynor, James William
目的：对于大多数新生儿来说，先天性心脏病（CHD）似乎是孤立的异常，大脑被认为具有正常的发育潜力。大多数神经发育研究。成果侧重于业务管理战略。研究方法：患有复杂CHD且除22 q11微缺失外未发现其他综合征的婴儿，在1岁时接受载脂蛋白E（APOE）多态性和发育结局研究评估;包括遗传评估和贝利婴儿发育量表-II [智力（MDI）和精神发育指数（PDI）]。结果：550名婴儿入组，501名幸存者中有359名（20名22 q11）（72%）返回。平均MDI为90 +/- 15，PDI为78 +/- 18。出生时未发现的遗传综合征确诊28例（8.1%），怀疑51例（15.0%）。多变量分析显示，疑似/确诊遗传综合征和APOE等位基因可预测MDI和PDI较低，所有p < 0.04。出生体重较低（p < 0.001）和术前插管（p = 0.012）预测MDI较低。初次手术期间较高的红细胞压积与较高的MDI相关（p = 0.007）。术后住院时间越长，PDI越低（p = 0.002）。体外循环辅助手术与较低的二尖瓣返流率和PDI相关（均p < 0.002），但使用深低温停循环与此无关。结论：患者因素（出生体重和术前状态）是神经发育结局的重要决定因素，而不是手术管理策略。在这个队列中，出生时未被怀疑的遗传综合征令人惊讶地常见，并与不良的神经发育结果相关。如果没有多个先天性异常，综合征可能会错过婴儿期。在所有患有CHD的婴儿中应考虑进行遗传评估。(C)2009年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: For most newborns, congenital heart defects (CHD) appear to be isolated anomalies and the brain is presumed to have normal developmental potential. Most studies of neurodevetopmental. outcomes have focused on operative management strategies. Methods: Infants with complex CHD and no identified syndromes other than 22q11 microdeletions, en rotted in a study of apolipoprotein E (APOE) polymorphisms and developmental outcome were evaluated at one year of age; including genetic evaluation and the Bayley Scales of Infant Devetopment-II [mental (MDI) and psychomotor developmental indices (PDI)]. Results: Five hundred and fifty infants enrolled and 359 (20 with 22q11) of 501 survivors (72%) returned. Mean MDI was 90 +/- 15 and PDI was 78 +/- 18. Genetic syndromes not identified at birth were confirmed in 28 (8.1%) and suspected in 51 (15.0%). By multivariable analysis, suspected/confirmed genetic syndromes and APOE epsilon 2 allele predicted lower MDI and PDI, all p < 0.04. Lower birth weight (p < 0.001) and preoperative intubation (p = 0.012) predicted lower MDI. Higher hematocrit during the initial operation was associated with higher MDI (p = 0.007). Longer postoperative length of stay was predictive of lower PDI (p = 0.002). Additional operations with cardiopulmonary bypass were associated with lower MIDI and PDI (both p < 0.002), but use of deep hypothermic circulatory arrest was not. Conclusions: Patient factors (birth weight and preoperative status) are significant determinants of neurodevelopmental outcomes as opposed to operative management strategies. In this cohort, genetic syndromes unsuspected at birth were surprisingly common and correlate with poor neurodevelopmental outcomes. Without multiple congenital anomalies, syndromes may be missed in infancy. Genetic evaluation should be considered in all infants with CHD. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.