A predictive model for neurodevelopmental outcome after the Norwood procedure. Pediatr Cardiol 2013 Feb;34(2):327-33
Date
08/07/2012Pubmed ID
22864647Pubmed Central ID
PMC3505274DOI
10.1007/s00246-012-0450-1Scopus ID
2-s2.0-84879500958 (requires institutional sign-in at Scopus site) 36 CitationsAbstract
Neurodevelopmental outcomes after the Norwood procedure for single right ventricular lesions are worse than those in the normal population. It would be valuable to identify which patients at the time of Norwood discharge are at greatest risk for neurodevelopmental impairment later in childhood. As such, this study sought to construct and validate a model to predict poor neurodevelopmental outcome using variables readily available to the clinician. Using data from the 14 month neurodevelopmental outcome of the Single-Ventricle Reconstruction (SVR) trial, a classification and regression tree (CART) analysis model was developed to predict severe neurodevelopmental impairment, defined as a Psychomotor Development Index (PDI) score lower than 70 on the Bayley Scales of Infant Development-II. The model then was validated using data from subjects enrolled in the Infant Single Ventricle (ISV) trial. The PDI scores were lower than 70 for 138 (44 %) of 313 subjects. Predictors of a PDI lower than 70 were post-Norwood intensive care unit (ICU) stay longer than 46 days, genetic syndrome or other anomalies, birth weight less than 2.7 kg, additional cardiac surgical procedures, and use of five or more medications at hospital discharge. Using these risk factors, the CART model correctly identified 75 % of SVR subjects with a PDI lower than 70. When the CART model was applied to 70 subjects from the ISV trial, the correct classification rate was 67 %. This model of variables from the Norwood hospitalization can help to identify infants at risk for neurodevelopmental impairment. However, given the overall high prevalence of neurodevelopmental impairment and the fact that nearly one third of severely affected children would not have been identified by these risk factors, close surveillance and assessment for early intervention services are warranted for all infants after the Norwood procedure.
Author List
Mahle WT, Lu M, Ohye RG, William Gaynor J, Goldberg CS, Sleeper LA, Pemberton VL, Mussatto KA, Williams IA, Sood E, Krawczeski CD, Lewis A, Mirarchi N, Scheurer M, Pasquali SK, Pinto N, Jacobs JP, McCrindle BW, Newburger JWAuthor
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of EngineeringMESH terms used to index this publication - Major topics in bold
Child DevelopmentDevelopmental Disabilities
Female
Humans
Hypoplastic Left Heart Syndrome
Incidence
Infant
Male
Models, Neurological
Neuropsychological Tests
Norwood Procedures
Postoperative Complications
Prognosis
Risk Assessment
Risk Factors
Survival Rate
United States