Stephen J. Roth

Publication Details

  • Clinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Mackie, A. S., Alton, G. Y., Dinu, I. A., Joffe, A. R., Roth, S. J., Newburger, J. W., Robertson, C. M. 2013; 145 (5): 1248-?


    Our goal was to determine if a clinical outcome score derived from early postoperative events is associated with 18- to 24-month Psychomotor Developmental Index (PDI) score among infants undergoing cardiopulmonary bypass surgery.We included infants aged ?6 weeks who underwent surgery during 2002-2006, all of whom were referred for neurodevelopmental evaluation at age 18 to 24 months. We excluded children with chromosomal abnormalities, hearing loss, cerebral palsy, or a Bayley III assessment. The prespecified clinical outcome score had a range of 0 to 7. Lower scores indicated a more rapid postoperative recovery. Patients requiring extracorporeal membrane oxygenation were assigned a score of 7.Ninety-nine subjects were included. Surgical procedures were arterial switch (n = 36), Norwood (n = 26), repair of total anomalous pulmonary venous connection (n = 16), and other (n = 21). Four subjects had postoperative extracorporeal membrane oxygenation. Clinical outcome scores were highest in the Norwood group (mean 4.1 ± 1.4) compared with the arterial switch group (1.9 ± 1.6) (P < .001), total anomalous pulmonary venous connection group (1.6 ± 2.0) (P < .001), and other group (3.3 ± 1.6, P = not significant). A mean decrease in PDI of 10.9 points (95% confidence interval, 4.9-16.9; P = .0005) was observed among children who had a clinical outcome score ?3, compared with those with a clinical outcome score <3. Time until lactate ?2.0 mmol/L increased with increasing clinical outcome score (P = .0003), as did highest 24-hour inotrope score (P < .0001).Clinical outcome scores of ?3 were associated with a significantly lower PDI at age 18 to 24 months. This score may be valuable as an end point when evaluating novel potential therapies for this high-risk population.

    View details for DOI 10.1016/j.jtcvs.2012.04.029

    View details for Web of Science ID 000317840600018

    View details for PubMedID 22959319

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