Goldstone Andrew B, Baiocchi Michael, Wypij David, Stopp Christian, Andropoulos Dean B, Atallah Joseph, Atz Andrew M, Beca John, Donofrio Mary T, Duncan Kim, Ghanayem Nancy S, Goldberg Caren S, Hövels-Gürich Hedwig, Ichida Fukiko, Jacobs Jeffrey P, Justo Robert, Latal Beatrice, Li Jennifer S, Mahle William T, McQuillen Patrick S, Menon Shaji C, Pike Nancy A, Pizarro Christian, Shekerdemian Lara S, Synnes Anne, Williams Ismée A, Bellinger David C, Newburger Jane, Gaynor J William
Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Stanford University, Stanford, CA, USA.
Eur J Cardiothorac Surg. 2020 Jan 1;57(1):63-71. doi: 10.1093/ejcts/ezz123.
Neurodevelopmental disability is the most common complication among congenital heart surgery survivors. The Bayley scales are standardized instruments to assess neurodevelopment. The most recent edition (Bayley Scales of Infant and Toddler Development 3rd Edition, Bayley-III) yields better-than-expected scores in typically developing and high-risk infants than the second edition (Bayley Scales of Infant Development 2nd Edition, BSID-II). We compared BSID-II and Bayley-III scores in infants undergoing cardiac surgery.
We evaluated 2198 infants who underwent operations with cardiopulmonary bypass between 1996 and 2009 at 26 institutions. We used propensity score matching to limit confounding by indication in a subset of patients (n = 705).
Overall, unadjusted Bayley-III motor scores were higher than BSID-II Psychomotor Development Index scores (90.7 ± 17.2 vs 77.6 ± 18.8, P < 0.001), and unadjusted Bayley-III composite cognitive and language scores were higher than BSID-II Mental Development Index scores (92.0 ± 15.4 vs 88.2 ± 16.7, P < 0.001). In the propensity-matched analysis, Bayley-III motor scores were higher than BSID-II Psychomotor Development Index scores [absolute difference 14.1, 95% confidence interval (CI) 11.7-17.6; P < 0.001] and the Bayley-III classified fewer children as having severe [odds ratio (OR) 0.24; 95% CI 0.14-0.42] or mild-to-moderate impairment (OR 0.21; 95% CI 0.14-0.32). The composite of Bayley-III cognitive and language scores was higher than BSID-II Mental Development Index scores (absolute difference 4.0, 95% CI 1.4-6.7; P = 0.003), but there was no difference between Bayley editions in the proportion of children classified as having severe cognitive and language impairment.
The Bayley-III yielded higher scores than the BSID-II and classified fewer children as severely impaired. The systematic bias towards higher scores with the Bayley-III precludes valid comparisons between early and contemporary cardiac surgery cohorts.
神经发育障碍是先天性心脏病手术幸存者中最常见的并发症。贝利量表是评估神经发育的标准化工具。最新版本（贝利婴幼儿发展量表第3版，Bayley-III）在正常发育和高危婴儿中产生的分数比第二版（贝利婴儿发展量表第2版，BSID-II）更好。我们比较了接受心脏手术婴儿的BSID-II和Bayley-III分数。
我们评估了1996年至2009年间在26家机构接受体外循环手术的2198名婴儿。我们使用倾向得分匹配来限制一部分患者（n = 705）因适应证导致的混杂因素。
总体而言，未经调整的Bayley-III运动分数高于BSID-II心理运动发展指数分数（90.7±17.2对77.6±18.8，P < 0.001），未经调整的Bayley-III综合认知和语言分数高于BSID-II智力发展指数分数（92.0±15.4对88.2±16.7，P < 0.001）。在倾向得分匹配分析中，Bayley-III运动分数高于BSID-II心理运动发展指数分数[绝对差异14.1，95%置信区间（CI）11.7 - 17.6；P < 0.001]，且Bayley-III将更少儿童归类为重度[优势比（OR）0.24；95% CI 0.14 - 0.42]或轻度至中度损伤（OR 0.21；95% CI 0.14 - 0.32）。Bayley-III认知和语言分数的综合得分高于BSID-II智力发展指数分数（绝对差异4.0，95% CI 1.4 - 6.7；P = 0.003），但在被归类为有严重认知和语言损伤的儿童比例方面，贝利版本之间没有差异。
Bayley-III产生的分数高于BSID-II，且将更少儿童归类为重度损伤。Bayley-III对高分的系统偏向使得早期和当代心脏手术队列之间无法进行有效比较。
