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Evaluation of neurodevelopmental impairments and risk factors in children following cardiac surgery: The first cohort from China

  • Author Footnotes
    † These authors have contributed equally to this work
    Jinqing Feng
    Footnotes
    † These authors have contributed equally to this work
    Affiliations
    Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China

    Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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  • Author Footnotes
    † These authors have contributed equally to this work
    Yani Zhang
    Footnotes
    † These authors have contributed equally to this work
    Affiliations
    Department of Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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  • Jinyuan Zhang
    Affiliations
    School of Health Management, Guangzhou Medical University, Guangzhou, China
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  • Techang Liu
    Affiliations
    Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
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  • Li Ma
    Affiliations
    Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China

    Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
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  • Minghui Zou
    Affiliations
    Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China

    Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
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  • Wenxiong Chen
    Affiliations
    Department of Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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  • Author Footnotes
    # These authors have contributed equally to this work
    Xinxin Chen
    Footnotes
    # These authors have contributed equally to this work
    Affiliations
    Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China

    Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China
    Search for articles by this author
  • Author Footnotes
    # These authors have contributed equally to this work
    Jia Li
    Correspondence
    Correspondence: Jia Li, MD, PhD, Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University. No.9 Jinsui Road, Tianhe District, Guangzhou, Guangdong Province, China.
    Footnotes
    # These authors have contributed equally to this work
    Affiliations
    Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Province, China

    Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
    Search for articles by this author
  • Author Footnotes
    † These authors have contributed equally to this work
    # These authors have contributed equally to this work
Open AccessPublished:March 17, 2023DOI:https://doi.org/10.1016/j.xjon.2023.03.005
Evaluation of neurodevelopmental impairments and risk factors in children following cardiac surgery: The first cohort from China
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      Abstract

      Objective

      Neurodevelopmental impairment has been realized as the most common complication in children with congenital heart disease (CHD) undergoing cardiac surgery in the past 30 years. But little attention has been paid to this problem in China. The potential risk factors for adverse outcomes include demographic, perioperative and socioeconomic factors which are vastly different in China compared to the developed countries in previous reports.

      Methods

      426 patients (aged 35.9±18.6 months) at about 1∼3 year follow-up after cardiac surgery were prospectively enrolled from March 2019 to February, 2022. Griffiths Mental Development Scales-Chinese was used to evaluate the quotients of overall development and 5 subscales of the child’s locomotor, language, personal-social, eye-hand coordination, and performance skills. Demographic, perioperative, socioeconomic, and feeding type in the first year of life (breast feeding, mixed or never breast feeding) were examined to identify the risk factors for adverse neurodevelopmental outcomes.

      Results

      Mean scores were 90.0±15.5 for development quotient, 92.3±19.4 for locomotor, 89.6±19.2 for personal-social, 85.5±21.7 for language, 90.3±17.2 for eye-hand coordination and 92±17.1 for performance subscales. For the entire cohort, the impairment in at least one subscale was found in 76.1% of the cohort (>1 SD below population mean) with 50.1% being severe (>2 SDs below the mean). The significant risk factors included prolonged hospital stay, peak level of postoperative CRP, socioeconomic status and never breast feeding or mix feeding.

      Conclusions

      Neurodevelopmental impairment is substantial in terms of incidence and severity in children with CHD undergoing cardiac surgery in China. Risk factors contributing to the adverse outcomes included prolonged hospital stay, early postoperative inflammatory response, socioeconomic status, and breast feeding or not. There is an urgent need for standardized follow-up and neurodevelopmental assessment in this special group of children in China.

      Keywords

      Abbreviations list:

      ACC (Aortic cross clamp), CHD (Congenital heart disease), CPB (Cardiopulmonary bypass), CICU (Cardiac intensive care unit), CRP (C-reactive protein), DHCA (Deep hypothermic circulatory arrest), DQ (Development quotient), ECMO (Extracorporeal membrane oxygenation), GDS-C (Griffiths Mental Development Scales-Chinese), IQ (Intelligence quotient), SES (Socioeconomic status), STS-EACTS (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery)

      Article info

      Publication history

      Accepted: March 9, 2023
      Received: January 4, 2023

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Jinqing Feng: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft. Yani Zhang: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing – original draft. Jinyuan Zhang: Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Visualization. Techang Liu: Investigation, Project administration, Resources, Software, Visualization. Li Ma: Conceptualization, Investigation, Project administration, Resources, Visualization. Minghui Zou: Conceptualization, Investigation, Project administration, Resources, Visualization. Wenxiong Chen: Conceptualization, Investigation, Project administration, Resources, Visualization. Xinxin Chen: Conceptualization, Investigation, Methodology, Project administration, Resources, Visualization. Jia Li: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – review & editing

      Conflict of interests: The authors declare that they have no conflict of interests.

      Funding: The Key-Area Research and Development Program of Guangdong Province (No. 2019B020227001); Jia Li’s start-up fund provided by Guangzhou Women and Children’s Medical Center.

      Institutional approval and Informed Consent: The study was reviewed and approved by Guangzhou Women and Children’s Medical Center institutional Research Ethics Boards. (No.46201; 2019-12-13)

      Central Message

      We found substantial neurodevelopmental impairment in incidence and severity in the first cohort of children with congenital heart disease at 1 to 3 years after cardiac surgery in China.

      Perspective Statement

      The significant risk factors contributing neurodevelopmental impairment included prolonged hospital stay, peak level of postoperative CRP, socioeconomic status and never breast feeding or mix feeding. There is an urgent need for standardized follow-up and neurodevelopmental assessment in this special group of children in China.

      Central Picture Legend: Significant risk factors contributing to neurodevelopment requirement in our model. Figure 1. Variability of the significant risk factors (postoperative hospital stay, socioeconomic status, peak level of C-reactive protein and feed type) contributing to neurodevelopment requirement in our model.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.03.005

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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