Later Delivery Improves to Neurodevelopment for Babies With CHD

May 24, 2011 — Children with congenital heart defects (CHD) who undergo heart surgery in infancy have better neurodevelopmental outcomes at age 4 if they were born closer to term (39 or 40 weeks gestational age). Researchers from the Cardiac Center at The Children’s Hospital of Philadelphia found better outcomes in infants born at greater than 39 weeks compared to infants born at 36 to 38 weeks.

Early delivery of a child with CHD is sometimes necessary because of concerns over maternal or fetal health. This research suggests that, in the absence of such concerns, elective or spontaneous delivery at 39-40 weeks is associated with better neurodevelopmental outcomes. This study has important implications for management of fetuses in whom a diagnosis of CHD is made before birth.

The study team presented their results at the annual meeting of the American Association for Thoracic Surgery in Philadelphia.

First study to examine neurodevelopmental outcomes in late pre-term infants

“Previous research has suggested that gestational age less than 39 weeks, even at 36-38 weeks, has been associated with increased mortality and morbidity in patients with CHD,“ said Donna A. Goff, MD, MS, a cardiologist at The Children’s Hospital of Philadelphia. “Ours was the first study to look closely at neurodevelopmental outcomes in late pre-term infants who had cardiac surgery during infancy.”

The researchers analyzed 351 infants who were born at 36 weeks gestation or later who were enrolled in a study for apolipoprotein-E (APOE) polymorphisms and neurodevelopmental outcome after infant cardiac surgery. Formal neurodevelopmental testing was performed at 4 years of age.

Tests include:

• Cognition
• Language skills
• Attention
• Impulsivity
• Memory
• Executive function
• Social competence
• Visual-motor skills
• Fine-motor skills

The median gestational age was 39 weeks with 125 patients born at 40 weeks or older. Older gestational age predicted better performance for short and long-term outcomes including cognition, visual-motor and fine-motor skills.

Contact

Joey McCool Ryan, The Children's Hospital of Philadelphia, 267-426-6070 or McCool@email.chop.edu