Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-26T06:21:43.515Z Has data issue: false hasContentIssue false
  • English
  • Français

Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation

Published online by Cambridge University Press:  02 September 2010

Gwen Y. Alton ,
Gwen R. Rempel ,
Charlene M. T. Robertson ,
Christine V. Newburn-Cook  and
Colleen M. Norris
Gwen Y. Alton*
Affiliation:
Glenrose Rehabilitation Hospital and Stollery Children’s Hospital, Edmonton, Alberta, Canada
Gwen R. Rempel
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Department of Pediatrics, Edmonton, Alberta, Canada
Charlene M. T. Robertson
Affiliation:
Outcome Evaluation & Research, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada Department of Pediatrics, Edmonton, Alberta, Canada
Christine V. Newburn-Cook
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
Colleen M. Norris
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Department of Cardiovascular Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
*
Correspondence to: G. Y. Alton, RN, MN, Complex Pediatric Therapies Follow-up Program, Glenrose Rehabilitation Hospital, 10230 – 111 Avenue, Room 242 GE, Edmonton, Alberta T5G 0B7, Canada. Tel: 780 735-7999 Ext: 15630; Fax: 780 735-6017; E-mail: gwen.alton@albertahealthservices.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Improvements in long-term survival of children undergoing the Norwood staged procedure and the arterial switch operation have resulted in the need to prepare these at-risk children for each stage of their developmental trajectory, including school readiness. This study describes and compares functional outcomes following the Norwood staged procedure and arterial switch operations.

Methods

This prospective inception cohort study comprised a sample of 73 children (71% boys) who had the Norwood staged procedure (n = 28) or the arterial switch operation (n = 45) at the age of 6 weeks or younger at the Stollery Children’s Hospital, Edmonton, Alberta, between 2002 and 2005. We excluded children who had chromosomal abnormalities or cerebral palsy. When children were 18–24 months of age, parents completed the Adaptive Behavioral Assessment System II. Standard scores for the domains are mean 100, standard deviation (15); skill area scaled scores, 10 (3). Student’s t-test with Bonferonni correction was used to compare groups.

Results

This population has greater than four times the number of children delayed on the General Adaptive Composite than the normative group. Functional outcomes were similar in the two groups other than those of home living (Norwood: 8.8 (2.8) compared with arterial switch: 11.2 (3.1), t = 3.389, p = 0.001) and self-care (Norwood: 5.9 (3.5) versus arterial switch: 8.1 (2.6), t = 3.140, p = 0.002).

Conclusion

These survivors are at increased risk for delayed functional abilities. Self-care, necessary for independence and confidence as children reach school age, was particularly low in the Norwood group. Reasons for low self-care abilities require further study.

Keywords

Congenital cardiac diseaseadaptive behaviourfunctional outcomesearly childhood developmenthypoplastic left heart syndrometransposition of the great arteries
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 6 , December 2010 , pp. 668 - 675
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wernovsky, G. Current insights regarding neurological and developmental abnormalities in children and young adults with complex congenital cardiac disease. Cardiol Young 2006; 16 (Suppl. 1): 92–104.CrossRefGoogle Scholar
2. Creighton, DE, Robertson, CMT, Sauvé, RS, et al. Neurocognitive, functional, and health outcomes at 5 years of age for children after complex cardiac surgery at 6 weeks of age or younger. Pediatrics 2007; 120: 478–486.CrossRefGoogle ScholarPubMed
3. Forbess, JM, Visconti, KJ, Hancock-Friesen, C, Howe, RC, Bellinger, DC, Jonas, RA. Neurodevelopmental outcome after congenital heart surgery: results from an institutional registry. Circulation 2002; 106 (Suppl. 1): I-95–I-102.CrossRefGoogle ScholarPubMed
4. Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141: 51–58.CrossRefGoogle ScholarPubMed
5. Shillingford, AJ, Wernovsky, G. Academic performance and behavioural difficulties after neonatal and infant heart surgery. Pediatr Clin North Am 2004; 51: 1625–1639.CrossRefGoogle ScholarPubMed
6. Mahle, WT, Clancy, RR, Moss, EM, Gerdes, M, Jobes, DR, Wernovsky, G. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics 2000; 105: 1082–1089.CrossRefGoogle ScholarPubMed
7. Majnemer, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkoc, C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr 2008; 153: 55–60.CrossRefGoogle ScholarPubMed
8. Sparrow, S, Balla, DA, Cicchhetti, DV. Vineland Adaptive Behavior Scales, Interview Edition. Survey Form Manual; a Revision of the Vineland Social Maturity Scale of EA Doll. American Guidance Service, Circle Pines, Minn, 1984.Google Scholar
9. Harrison, PL, Oakland, T. Manual for the Adaptive Behaviour Assessment System II. PsychCorp. Harcourt Assessment Inc., San Antonio, Texas, 2003.Google Scholar
10. Horn, E, Fuchs, D. Using adaptive behaviour in assessment and intervention: an overview. J Spec Educ 1987; 21: 11–26.CrossRefGoogle Scholar
11. McGrew, K, Bruininks, R. The factor structure of adaptive behaviour. School Psych Rev 1989; 18: 64–81.CrossRefGoogle Scholar
12. American Association on Mental Retardation. Mental Retardation: Definition, Classification, and Systems of Support. American Association on Mental Retardation, Washington, DC, 2002b.Google Scholar
13. Diagnostic and Statistical Manual of Mental Disorders, 4 edn, Text Revision, DSM-IV-TR; American Psychiatric Association (APA), 2000.Google Scholar
14. Robertson, CMT, Joffe, AR, Sauvé, RS, et al. Outcomes from an interprovincial program of newborn open heart surgery. J Pediatr 2004; 144: 86–92.CrossRefGoogle ScholarPubMed
15. Neufeld, RE, Clark, BG, Robertson, CMT, et al. Five-year neurocognitive and health outcome after neonatal arterial switch operations. J Thorac Cardiovasc Surg 2008; 136: 1413–1421.CrossRefGoogle Scholar
16. Atallah, J, Dinu, IA, Joffe, AR, et al. Two-year survival and mental and psychomotor outcomes after the Norwood procedure: an analysis of the modified Blalock-Taussig shunt and right ventricle to pulmonary artery shunt surgical eras. Circulation 2008; 118: 1410–1418.CrossRefGoogle ScholarPubMed
17. Blishen, BR. The 1981 socioeconomic index for occupations in Canada. Can Res Soc Anth 1987; 24: 465–488.Google Scholar
18. Harrison, PL, Oakland, T. Manual for the Adaptive Behaviour Assessment System II. Table B.8, p 281. PsychCorp. Harcourt Assessment Inc., San Antonio, Texas, 2003.Google Scholar
19. Limperopoulos, C, Majnemer, A, Shevell, M, et al. Functional limitation in young children with congenital heart defects after cardiac surgery. Pediatrics 2001; 108: 1325–1331.CrossRefGoogle ScholarPubMed
20. Majnemer, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Health and well-being of children with congenital cardiac malformations, and their families, following open-heart surgery. Cardiol Young 2006; 16: 157–164.CrossRefGoogle ScholarPubMed
21. Limperopoulos, C, Majnemer, A, Shevell, MI, Rosenblatt, B, Roblicek, C, Tchervenkov, C. Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr 2000; 137: 638–645.CrossRefGoogle ScholarPubMed
22. Rogers, BT, Msall, ME, Buck, GM, et al. Neurodevelopmental outcome of infants with hypoplastic left heart syndrome. J Pediatr 1995; 126: 497–499.CrossRefGoogle ScholarPubMed
23. Kern, JH, Hinton, VJ, Nereo, NE, Hayes, CJ, Welton, M. Early developmental outcome after the Norwood procedure for hypoplastic left heart syndrome. Pediatrics 1998; 102: 1148–1152.CrossRefGoogle ScholarPubMed
24. Karl, TR, Hall, S, Ford, G, et al. Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: neurodevelopmental outcome. J Thorac Cardiovasc Surg 2004; 127: 213–222.CrossRefGoogle ScholarPubMed
25. Bellinger, DC, Wypiij, D, duPlessis, AJ, et al. Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston circulatory arrest trial. J Thorac Cardiovasc Surg 2003; 126: 1385–1396.CrossRefGoogle ScholarPubMed
26. Bellinger, DC. Are children with congenital cardiac malformations at increased risk of deficits in social cognition? Cardiol Young 2008; 18: 3–9.CrossRefGoogle ScholarPubMed
27. Hagemo, PS, Skarbo, AB, Rasmussen, M, Fredriksen, PM, Schage, S. An extensive long term follow-up of a cohort of patients with hypoplasia of the left heart. Cardiol Young 2007; 17: 51–55.CrossRefGoogle ScholarPubMed
28. Rempel, GR, Harrison, MJ. Safeguarding precarious survival: parenting children who have life-threatening heart disease. Qual Health Res 2007; 17: 824–837.CrossRefGoogle ScholarPubMed
29. Majnemer, A, Mazer, B, Lecker, E, et al. Patterns of use of educational and rehabilitation services at school age for children with congenitally malformed hearts. Cardiol Young 2008; 18: 288–296.CrossRefGoogle ScholarPubMed
30. Spittle, AJ, Orton, J, Doyle, LW, Boyd, R. Early developmental intervention programs post-hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Vol 1, 2009 (no page number).Google Scholar
31. Resnick, MB, Eyler, FC, Nelson, RM, Eitzman, DV, Bucciarelli, RL. Developmental intervention for low birth weight infants: improved early developmental outcome. Pediatrics 1987; 80: 68–74.CrossRefGoogle Scholar
32. Gleason, TR, Evans, ME. Perceived vulnerability: a comparison of parents and children. J Child Health Care 2004; 8: 279–287.CrossRefGoogle ScholarPubMed
33. Rempel, G, Harrison, MJ, Williamson, DL. Is “treat your child normally” helpful advice for parents of survivors of treatment of hypoplastic left heart syndrome? Cardiol Young 2008; 19: 135–144.CrossRefGoogle Scholar