Feng Jinqing, Zhang Yani, Zhang Jinyuan, Liu Techang, Ma Li, Zou Minghui, Chen Wenxiong, Chen Xinxin, Li Jia
Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
JTCVS Open. 2023 Mar 17;14:462-471. doi: 10.1016/j.xjon.2023.03.005. eCollection 2023 Jun.
Neurodevelopmental impairment has been realized as the most common complication in children with congenital heart disease undergoing cardiac surgery during the past 30 years. But little attention has been paid to this problem in China. The potential risk factors for adverse outcomes include demographic, perioperative, and socioeconomic factors, which are vastly different in China compared with the developed countries in previous reports.
Four hundred twenty-six patients (aged 35.9 ± 18.6 months) at about 1- to 3-year follow-up after cardiac surgery were prospectively enrolled from March 2019 to February 2022. Griffiths Mental Development Scales-Chinese was used to evaluate the quotients of overall development and 5 subscales of the child's locomotor, language, personal-social, eye-hand coordination, and performance skills. Demographic, perioperative, socioeconomic, and feeding type during the first year of life (breastfeeding, mixed, or never breastfeeding) were examined to identify the risk factors for adverse neurodevelopmental outcomes.
Mean scores were 90.0 ± 15.5 for development quotient, 92.3 ± 19.4 for locomotor, 89.6 ± 19.2 for personal-social, 85.5 ± 21.7 for language, 90.3 ± 17.2 for eye-hand coordination, and 92 ± 17.1 for performance subscales. For the entire cohort, the impairment in at least 1 subscale was found in 76.1% of the cohort (>1 SD below population mean) with 50.1% being severe (>2 SDs below the mean). The significant risk factors included prolonged hospital stay, peak level of postoperative C-reactive protein, socioeconomic status, and never breastfeeding or mixed feeding.
Neurodevelopmental impairment is substantial in terms of incidence and severity in children with congenital heart disease undergoing cardiac surgery in China. Risk factors contributing to the adverse outcomes included prolonged hospital stay, early postoperative inflammatory response, socioeconomic status, and never breastfeeding or mixed feeding. There is an urgent need for standardized follow-up and neurodevelopmental assessment in this special group of children in China.
在过去30年中，神经发育障碍已被认为是先天性心脏病患儿心脏手术后最常见的并发症。但在中国，这个问题很少受到关注。不良结局的潜在风险因素包括人口统计学、围手术期和社会经济因素，与先前报道的发达国家相比，这些因素在中国有很大差异。
从2019年3月至2022年2月前瞻性纳入426例心脏手术后约1至3年随访的患者（年龄35.9±18.6个月）。使用格里菲斯心理发展量表中文版评估儿童的总体发育商以及运动、语言、个人社交、手眼协调和操作技能5个子量表的商数。研究人口统计学、围手术期、社会经济状况以及出生后第一年的喂养方式（母乳喂养、混合喂养或从未母乳喂养），以确定神经发育不良结局的风险因素。
发育商平均分为90.0±15.5，运动子量表为92.3±19.4，个人社交子量表为89.6±19.2，语言子量表为85.5±21.7，手眼协调子量表为90.3±17.2，操作子量表为92±17.1。在整个队列中，76.1%的队列至少有1个子量表受损（低于人群均值1个标准差以上），50.1%为重度受损（低于均值2个标准差以上）。显著风险因素包括住院时间延长、术后C反应蛋白峰值水平、社会经济状况以及从未母乳喂养或混合喂养。
在中国，先天性心脏病患儿心脏手术后神经发育障碍在发病率和严重程度方面都很严重。导致不良结局的风险因素包括住院时间延长、术后早期炎症反应、社会经济状况以及从未母乳喂养或混合喂养。在中国，这一特殊儿童群体迫切需要标准化的随访和神经发育评估。
