Early functional health outcomes for infants and their families who have undergone arterial switch or Norwood procedures

Abstract

Background: This Program assessed the impact on functional health, in the current era, of cardiac bypass surgery on a cohort of neonates at risk of neurodevelopmental disability. Methods: Infants undergoing Arterial Switch Operation (ASO) or Norwood procedure from January 2013 were enrolled prospectively into the Neurodevelopmental Program. Demographic and clinical data were analysed. Bayley Scales of Development Third Edition, Health-Related Quality of Life (HRQoL) and Parenting Stress assessments were performed at 6, 12 and 24 months. Results: ASO patients had median Comprehensive Aristotle Complexity Scores (CACS) of 12 (IQR 10 - 14) and intensive care (PICU) stay of 8.8 days (IQR 6.0-11.9). Norwood infants had median CACS of 17 (IQR 14 - 20) and PICU stay of 21.4 days (IQR 16.1-27.1). Infants were assessed at 6 (ASO: n=25, Norwood: n=13), 12 (ASO: n= 20, Norwood: n=8) and 24 months (ASO: n=7, Norwood: n=3). ASO infants scored in low average range in adaptive behaviour at 12 months (86.9±24.5), and at least average range across other domains at 6, 12 and 24 months. Norwood infants scored in low average range in adaptive behaviour but average range across all domains at 6 months. Subsequently they scored in low average-borderline range; in language (12 month: 83.6±35.9, 24 month: 85.3±33.2), motor (12 month: 71.9 ±29.8, 24 month: 86.3±21.5) and adaptive behaviour (6 month: 88.64± 30.4, 12 month: 85.9±12.4, 24 month: 77.7±23.0) domains. Parent-reported total HRQoL was significantly lower in ASOgroup at 6 months only. Lower total HRQoL in the Norwood group was persistent at 12 months. Parenting stress was in the normal range for both groups at all time point. Conclusion: Study findings suggest that infants undergoing the Norwood procedure have reduced functional health when followed beyond 12 months.L6200771392018-01-09 <br />