RESUMEN
BACKGROUND: The purpose of this study was to determine the prevalence of persistent neurodevelopmental sequelae in 1-year-old infants after open heart surgery for congenital heart disease, using the Bayley Scales of Infant Development second edition (BSID-II). A secondary objective was to confirm the applicability and usefulness of the BSID-II in Japanese infants. METHODS: Thirty-nine infants who underwent repair of a ventricular septal defect before 6 months of age and 108 normal Japanese infants at 1 year of age were assessed using the BSID-II. RESULTS: In normal infants, scores on the Mental Development Index and the Psychomotor Development Index components of the BSID-II ranged from borderline retardation to very superior following a normal distribution similar to those obtained for US controls. No problems were encountered, either in translation or in following the instructions when the BSID-II was used to evaluate the 1-year-old Japanese infants. On the other hand, the mean scores on the Mental Development Index and the Psychomotor Development Index were significantly lower in Japanese patients than in normal Japanese infants, particularly for gross motor development (P < 0.001). Linear regression analysis showed that a longer intensive care unit stay was associated with impaired cognitive development at 1 year of age (P= 0.03). CONCLUSIONS: Neurodevelopmental functions in 1-year-old infants with congenital heart disease were lower than those in normal infants, especially for gross motor function using the BSID-II. One risk factor that correlated with neurodevelopmental sequelae was the length of intensive care unit stay.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/etiología , Defectos del Tabique Interventricular/psicología , Defectos del Tabique Interventricular/cirugía , Distribución por Edad , Análisis de Varianza , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Estudios de Casos y Controles , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/fisiopatología , Discapacidades del Desarrollo/fisiopatología , Femenino , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/psicología , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Japón/epidemiología , Discapacidades para el Aprendizaje/epidemiología , Discapacidades para el Aprendizaje/etiología , Discapacidades para el Aprendizaje/fisiopatología , Modelos Lineales , Masculino , Trastornos de la Destreza Motora/epidemiología , Trastornos de la Destreza Motora/etiología , Trastornos de la Destreza Motora/fisiopatología , Pruebas Neuropsicológicas , Cuidados Posoperatorios/métodos , Prevalencia , Pronóstico , Pruebas Psicológicas , Trastornos Psicomotores/epidemiología , Trastornos Psicomotores/etiología , Trastornos Psicomotores/fisiopatología , Estudios Retrospectivos , Distribución por SexoRESUMEN
OBJECTIVES: We performed a regional volumetric study of the brain using 3-dimensional magnetic resonance imaging in infants with congenital heart disease to search for variables in anatomic development of the brain that may be associated with functional impairment. METHODS: Forty infants with congenital heart disease-17 infants with single ventricle physiology, 5 with transposition of great arteries, and 18 with ventricular septal defect-were studied prospectively by 3-dimensional magnetic resonance imaging of the brain several months after heart surgery. RESULTS: The global volume of gray matter was significantly reduced in the patients with congenital heart disease compared with normal controls (P < .001), whereas no significant difference in the volume of white matter was observed. Further, the decrease in gray matter volume was more apparent in the frontal lobe than in the temporal lobe, especially in infants with single ventricle physiology or transposition of the great arteries. Multivariate analysis revealed that preoperative hypoxia is strongly associated with decreased frontal gray matter volume (P < .01), as well as a diagnosis of hypoplastic left heart syndrome (P < .05). Of note, frontal gray matter volume, which includes the motor area, correlated weakly with psychomotor developmental index scores (P < .01). CONCLUSIONS: Brain developmental impairment occurs in many infants with congenital heart disease, especially in those who have preoperative hypoxia and critical congenital heart disease. This quantitative volumetric study encourages larger scale and longitudinal follow-up to elucidate the significance of impaired neuroanatomic development on functional outcome.
Asunto(s)
Encéfalo/crecimiento & desarrollo , Discapacidades del Desarrollo/etiología , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/fisiopatología , Imagenología Tridimensional , Imagen por Resonancia Magnética , Femenino , Humanos , Lactante , Masculino , Tamaño de los Órganos , Estudios ProspectivosRESUMEN
The Bayley Scales of Infant Development 2nd edition (BSID-II) is used worldwide as a test for assessing development in infants with congenital heart disease (CHD); however, a Japanese version of these tests is not available. To introduce BSID-II in Japan, it was first used for 1-year-old Japanese infants with and without CHD (controls). The BSID-II scores of the control group were lower than American standards. In addition, the scores of the infants with CHD were lower than those of the controls, particularly the scores for motor development. Tsumori's Mental Development Test scores for the two groups were comparable; however, a diverse correlation was observed between BSID-II and Tsumori's Mental Development Test. No problems were encountered during the translation and use of BSID-II. These results suggest that BSID-II is useful for the assessment of development in Japanese infants.