Monday, April 27, 2015

Neurodevelopmental Outcomes in Infants Who Experienced Cardiac Surgery: Are We Doing Better?

By: Lewis First, MD, MS; Editor-in-Chief    

          There have been a number of studies that have focused on neurodevelopmental differences in children who as infants undergo cardiac surgery for their congenital heart lesion.  Etiologies for these differences may range from simply hypoxia to the brain to the use of anesthetic agents—but given the decades of ongoing improvement in our surgical techniques—are we seeing better and better outcomes neurodevelopmentally as well?  Gaynor et al. (doi:10.1542/peds.2014-3825) get to the heart of the matter in an interesting study being released this week.  The authors reviewed all studies of developmental outcome in infants undergoing cardiac surgery from 1996 through 2009 to determine risk factors for poorer developmental outcomes.   
     Once one adjusts for these innate risk factors, one begins to see developmental improvement over time—but there is much more to learn from this study and to think about—since developmental abnormalities continue to be seen in this surgical population of patients. Dr. Leonard Rappaport, a behavioral and developmental pediatrician who published some of the earliest studies on developmental outcomes in infants undergoing cardiac surgery shares his perspective on how far we have come and yet how far we still need to go in an accompanying commentary (doi: 10.1542/peds.2015-0719) well worth reading along with this heartfelt summary of where we are developmentally over the past decade and a half of congenital cardiac surgical care.

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