A review and analysis of early congenital heart surgery and anesthesia and associated neurodevelopmental outcomes
Background: Congenital heart defects (CHDs) are the most common birth defect, affecting 35,000 of the over 4 million births each year in the United States (Roger et al., 2012). With an increase in survival rates, the focus of pediatric cardiologists has shifted from prolonging life to quality of life issues, such as neurodevelopment and neurologic deficits. While numerous studies have indicated that CHD patients are at risk for neurologic complications, the causes of neurologic morbidity among CHD patients are not thoroughly understood. ^ Methods: First, a systematic review was conducted describing the neurodevelopmental outcomes after early CHD surgery, for both early and later childhood outcomes. This review was an update to a prior review, published by Snookes, et al (2010), with improved methodology, including a well-refined and expanded search strategy. Second, an examination was performed of the anesthetic risk factors for poorer neurodevelopmental outcomes at one year of age in CHD survivors. Linear regression analyses were conducted assessing the exposures of benzodiazepines and opioids and cognitive, language and motor neurodevelopmental outcomes. Lastly, an analysis was completed comparing differences among CHD lesion groups (single vs. two ventricle) over time for four selected biochemical markers (NAA:creatine, NAA:choline, myo-inositol:creatine and myo-inositol:choline), in four selected regions of interest (left and right thalamus and basal ganglia). This was done via longitudinal mixed models analyses of metabolite ratios by single vs. two ventricle patients by postconceptional age. ^ Results: A total of 22 cohorts (80 publications) were included in this updated systematic review. Of these 22 cohorts, 11 were newly published and 3 met the inclusion criteria for the prior review. In general, deficits in cognitive, language and motor scores were reported among reports of early childhood outcomes. Although most reports of preschool and school age outcomes did not indicate differences in CHD cases for cognition, language or motor compared to the general population, there are still very few studies with published reports in these age groups. The results of the analyses assessing anesthetic exposure and neurodevelopmental outcomes did not indicate any negative associations after adjusting for relevant covariates for any of the exposure-outcome relationships. However, a small positive association was observed between benzodiazepine exposure and motor outcomes that was preserved in the multivariable model. The findings also did not indicate any differences in the maturation rates of any metabolite ratios in any region by CHD lesion group. The analysis also provided an incidental finding of a lack of expected increase post-surgery for NAA:creatine in the thalamus average and in the average across all four regions. ^ Summary: The results of this dissertation add to the growing body of literature on neurodevelopmental outcomes and potential risk factors in the CHD population. The need remains for a new, large, longitudinal cohort study to assess risk factors of poorer neurodevelopment and to determine the extent of neurologic insults and outcomes beyond early childhood.^
Meador, Marcie R, "A review and analysis of early congenital heart surgery and anesthesia and associated neurodevelopmental outcomes" (2015). Texas Medical Center Dissertations (via ProQuest). AAI3737096.