6420 Neuro-developmental outcomes after infant heart surgery for congenital heart disease – a hospital based multi-centre prospective cohort study from India

Objectives Neurodevelopmental disability is the most common long-term consequence for survivors of surgery for congenital heart disease (CHD). The primary objectives of this prospective multi-centre hospital-based cohort study were to determine the prevalence and predictors of motor and mental neurodevelopmental delay using the developmental assessment scale for Indian infants (DASII) at six months after corrective cardiac surgery using bypass from five centres across India. Methods We followed up 1143 infants who were operated for CHD in the first year of life. Infants were recruited from five tertiary cardiac care centres across India – Delhi, Mumbai, Kolkata, Bangalore and Kochi. Neuro-developmental assessment was done in hospital using DASII in a designated neurodevelopmental assessment room by trained Neuro-developmental assessors recruited for this study. We reported the prevalence of motor as well as mental neurodevelopmental delay in general as well as stratified for 14 clusters as per DASII. We did logistic regression to report the adjusted Odds Ratios for predictors of overall motor and mental developmental delay. Results The estimated sample size was 1250 based on Gaynor et al.¹ We recruited 1143 infants. A total of 995 infants (87%) were alive at six months after cardiac surgery. A total of 92 infants (8.0%) expired in hospital and another 56 (4.9%) expired during follow up after discharge. We analysed data from remaining 816 infants. A total of 234 infants (28.7%) had motor developmental delay and 143 (17.5%) had mental developmental delay. In cluster-based analysis, maximum delay was seen for body control among motor clusters (n 455, 55.8%). Social interaction and imitative behaviour showed maximum delay (n 382, 46.8%) among mental clusters. Significant predictors for motor delay included syndromic association (OR 11.8, 95% CI 5.3, 26.5), preoperative condition as measured by PRACHS score (OR 1.2, 95% CI 1.04,1.4) and duration of mechanical ventilation in hours (OR 1.003, 95% CI 1.001 – 1.004). The corresponding predictors for mental delay were syndromic association (OR 19.3, 95% CI 9.3, 39.9), post-operative sepsis (OR 2.0, 95% CI 1.1, 3.7) and duration of mechanical ventilation in hours (OR 1.003, 95% CI 1.002, 1.005). Conclusion A significant proportion of survivors of CHD surgery during infancy experience neurodevelopmental morbidity. Significant predictors of neurodevelopmental delay include syndromic association, preoperative condition, post-operative sepsis and duration of mechanical ventilation. Cluster based developmental assessment shows delays in multiple sub-domains. As more high-risk CHD infants undergo cardiac surgery and survive in low resource settings like India, a growing population will require significant societal resources. Reference Gaynor JW, Stopp C, Wypij D, Andropoulos DB, Atallah J, Atz AM, Beca J, Donofrio MT, Duncan K, Ghanayem NS, Goldberg CS, Hövels-Gürich H, Ichida F, Jacobs JP, Justo R, Latal B, Li JS, Mahle WT, McQuillen PS, Menon SC, Pemberton VL, Pike NA, Pizarro C, Shekerdemian LS, Synnes A, Williams I, Bellinger DC, Newburger JW, International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics. 2015 May;135(5):816–25.