Abstract 13230: Factors Associated with Impaired Neurodevelopment at 3 Years of Age in Children with Single Right Ventricle Lesions
Background: Impaired neurodevelopment (ND) is a significant morbidity for many children with hypoplastic left heart syndrome and other single right ventricle anomalies (SV). Early recognition of delayed ND is crucial, yet the possible predictors of ND impairment, including early developmental assessments, remain unclear. In the Single Ventricle Reconstruction (SVR) Extension Study, we assessed the relationship of ND at 3 yrs to Norwood shunt type, 14-mo developmental scores, and demographic and interim medical factors.
Methods: Transplant-free survivors in the SVR trial were eligible for inclusion. Annual medical history, including measures of growth, feeding, complications and serious events, were assessed through record review and structured phone interview. The SVR trial included ND assessment at 14 mo with the Bayley Scales of Infant Development 2nd edition (BSID-II) Psychomotor Development Index (PDI) and Mental Development Index (MDI). The Ages and Stages Questionnaire (ASQ) was completed at 3 yrs to assess 5 domains: Communication, Gross Motor, Fine Motor, Problem Solving, and Personal Social. ASQ scores were analyzed as dichotomous (>2 SD below normal mean=impaired) and as continuous outcomes.
Results: Of 277 pts eligible for 3-yr ND evaluation, 203 (73%) completed the ASQ. Scores on each ASQ domain were significantly lower than normal (p<.001). Shunt type was not associated with any ASQ domain score. Of subjects with a 3-yr ASQ, 188 had 14-mo BSID-II. PDI and MDI <70 were associated with higher odds of impairment on each 3-yr ASQ domain score (ORs: 3.4- 6.9, p<.001 for PDI; ORs: 8.8-20.6, p<.001 for MDI). However, 3-yr ASQ domain scores varied nonlinearly with PDI and MDI; piecewise models indicated that BSID-II indices were most predictive of ASQ scores when PDI was <70 (R2=.23-.29, p<.001), or MDI was <85 (R2=.29-.37, p<.001). More complications and serious adverse events were associated with low ASQ domain scores.
Conclusion: Children with SV have impaired ND at 3 yrs, with lower ASQ scores associated with measures of medical morbidity but not with Norwood shunt type. PDI<70 and MDI<85 on 14-mo BSID-II are positively correlated with 3-yr ASQ scores, supporting the predictive validity of early developmental testing in this at-risk population.
- © 2012 by American Heart Association, Inc.