TOPLINE

Premature infants with congenital heart disease (CHD) who underwent cardiac surgery had significantly worse neurodevelopmental outcomes than those born at term, with the lowest motor and cognitive scores observed in infants born at ≤ 33 weeks. 

METHODOLOGY

• Researchers conducted a single-center, retrospective cohort study using data from children with CHD, born between 2007 and 2020, who underwent cardiac surgery during infancy.
• A total of 513 children completed neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, Third Edition, at a median age of 26 months.
• Participants were stratified by gestational age into 4 groups: extremely/very/moderately preterm (≤ 33 weeks), late-preterm (34-36 weeks), early-term (37-38 weeks), or term/postterm (≥ 39 weeks); 87% were full term and 13% were preterm.
• Outcome measures included cognitive, language, and motor composite scores assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Independent predictors of neurodevelopmental outcomes were also identified.
• The analysis was adjusted for demographic, medical, and surgical covariates.

TAKEAWAY

• Compared with children born at term, cognitive scores were significantly lower in those born at ≤ 33 weeks (difference in mean scores, -10.1; P = .003), at 34-36 weeks (difference in mean scores, -6.6; P = .007), and at 37-38 weeks (difference in mean scores, -4.0; P = .011). 
• Compared with children born at term, language scores were significantly lower in those born at 34-36 weeks (difference in mean scores, -8.0; P = .008) and 37-38 weeks (difference in mean scores, -4.5; P = .018), but not in those born at ≤ 33 weeks.
• Compared with children born at term, motor scores were significantly lower in those born at ≤ 33 weeks (difference in mean scores, -15.7; P < .001), at 34-36 weeks (difference in mean scores, -9.1; P < .001), and at 37-38 weeks (difference in mean scores, -5.9; P < .001).
• Even after adjustment, the poorest outcomes were observed in children born at ≤ 33 weeks, with mean cognitive and motor scores 11 and 15 points lower, respectively, than those of term infants. Additional independent risk factors were a lower caregiver education level, Black race, a longer duration of hospitalization, and the presence of a genetic diagnosis.

IN PRACTICE

"Prematurity is a significant risk factor for adverse cognitive and motor outcomes in children with CHD, especially in those born ≤33 weeks. Enhanced neurodevelopmental surveillance and targeted early intervention strategies are warranted for this vulnerable population," the authors wrote.

SOURCE

The study was led by Jenna A. Katz, MD, Boston Children's Hospital, Massachusetts. It was published online on August 20 in the Journal of the American Heart Association.

LIMITATIONS

The study was limited by its retrospective, single-center design. The exclusion of infants who did not undergo cardiac surgery limited the generalizability of the findings. Substantial loss to follow-up may have biased the cohort toward higher developmental scores, as children who returned for assessment were more often White and non-Hispanic and less likely to have single-ventricle heart disease. Additionally, neurodevelopmental outcomes could not be correlated with white matter or other MRI-based brain abnormalities.

DISCLOSURES

Funding information for the study was not provided. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.