Department of Pediatric Rehabilitation and Development, Advocate Children's Hospital, Oak Lawn, IL, USA.
University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.
Dev Med Child Neurol. 2021 Jan;63(1):29-46. doi: 10.1111/dmcn.14512. Epub 2020 Mar 9.
(1) To systematically review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease (CHD) who underwent early surgery; (2) to run a meta-regression analysis on the Bayley Scales of Infant Development, Second Edition Mental Developmental Index and Psychomotor Developmental Index (PDI) of infants up to 24 months and IQs of preschool-aged children to adolescents; (3) to assess associations between perioperative risk factors and outcomes.
We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed.
In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single-ventricle CHD was inferior to those with two-ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative risk factors were inconsistently associated with developmental outcomes.
The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes.
（1）系统综述婴儿期至青春期患有复杂先天性心脏病（CHD）且早期接受手术的儿童的发育结果的文献；（2）对婴儿期至 24 个月的贝利婴幼儿发展量表第二版心理发育指数和运动发育指数（PDI）和学龄前儿童至青少年的智商进行荟萃回归分析；（3）评估围手术期危险因素与结果之间的关系。
我们在 PubMed、Embase、CINAHL 和 PsycINFO 中搜索了相关文献（1990 年 1 月至 2019 年 1 月）。纳入标准包括在生命的前 9 周内接受过主要手术的患有复杂 CHD 的婴儿。评估了方法学质量，包括偏倚风险和内部有效性。
共有 185 篇论文符合纳入标准；对其中 100 篇具有较高和中等方法学质量的论文进行了详细分析。CHD 组和方法学之间存在很大的异质性。单心室 CHD 患儿的预后明显差于双心室 CHD 患儿（分别为 PDI 平均得分 77 和 88；智力得分 92 和 98）。围手术期危险因素与发育结果的相关性不一致。
关于婴儿早期接受手术的儿童的文献表明，单心室的婴儿发生不良发育结果的风险最高。
