Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life.

Autor:	Ricci MF; Division of Developmental Pediatrics, Department of Pediatrics., Andersen JC; Division of Developmental Pediatrics, Department of Pediatrics, Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Canada; and., Joffe AR; Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada., Watt MJ; Division of Developmental Pediatrics, Department of Pediatrics, Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Canada; and., Moez EK; School of Public Health, and., Dinu IA; School of Public Health, and., Garcia Guerra G; Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada., Ross DB; Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada;, Rebeyka IM; Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada;, Robertson CM; Division of Developmental Pediatrics, Department of Pediatrics, Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Canada; and Charlene.Robertson@albertahealthservices.ca.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2015 Oct; Vol. 136 (4), pp. e922-33. Date of Electronic Publication: 2015 Sep 21.
DOI:	10.1542/peds.2015-1879
Abstrakt:	Background and Objectives: Little is known about chronic neuromotor disability (CND) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery (CCS). We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors. Methods: This prospective follow-up study included 549 children after CCS requiring cardiopulmonary bypass at ≤6 weeks of age. Groups included those with only 1 CCS, mostly biventricular CHD, and those with >1 CCS, predominantly single ventricle defects. At 4.5 years of age, 420 (94.6%) children received multidisciplinary assessment. Frequency of CND is given as percentage of assessed survivors. Predictors of CND were analyzed using multiple logistic regression analysis. Results: CND occurred in 6% (95% confidence interval [CI] 3.7%-8.2%) of 4.5-year survivors; for 1 CCS, 4.2% (CI 2.3%-6.1%) and >1, 9.8% (CI 7%-12.6%). CND presentation showed: hemiparesis, 72%; spasticity, 80%; ambulation, 72%; intellectual disability, 44%; autism, 16%; epilepsy, 12%; permanent vision and hearing impairment, 12% and 8%, respectively. Overall, 32% of presumed causative events happened before first CCS. Independent odds ratio for CND are age (days) at first CCS, 1.08 (CI 1.04-1.12; P < .001); highest plasma lactate before first CCS (mmol/L), 1.13 (CI 1.03-1.23; P = 0.008); and >1 CCS, 3.57 (CI 1.48-8.9; P = .005). Conclusions: CND is not uncommon among CCS survivors. The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population. Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND. (Copyright © 2015 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu