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Residual Lesion Severity Is Associated With Adverse Neurodevelopmental Outcomes In Young Children With Congenital Heart Disease
Aditya Sengupta, MD, MPH, Kimberlee Gauvreau, ScD, Anjali Sadhwani, PhD, Samantha C. Butler, PhD, Jane W. Newburger, MD, MPH, Pedro J. del Nido, MD, Meena Nathan, MD, MPH
Boston Children's Hospital, Boston, MA, USA.

Objective(s): We assessed the Residual Lesion Score (RLS), a quality improvement metric that assesses residual lesion severity following congenital heart surgery (CHS), as a predictor of neurodevelopmental (ND) delay.
Methods: This was a single-center review of patients who underwent CHS from 01/2011-12/2019 and received post-discharge ND evaluation between the ages of 12 and 42 months using the Bayley Scales of Infant Development, 3rd ed. (BSID-3). RLS was assigned at discharge per published criteria: RLS-1, no residua; RLS-2, minor residua; RLS-3, major residua or in-hospital unplanned reintervention. Associations between RLS and BSID-3 scores were evaluated using multivariable linear regression. Linear mixed-effects models assessed trends in outcomes over time.
Results: Of 477 patients with mean age at ND testing of 21.26.1 months, 282 (59.1%), 132 (27.7%), and 63 (13.2%) patients had RLS-1, 2, and 3 lesions, respectively. Table 1A shows BSID-3 outcomes by RLS. On multivariable analysis, RLS-3 patients had significantly lower cognitive, receptive and expressive communication, and fine and gross motor scaled scores, compared to RLS-1 patients (Table 1B). In a sub-group analysis of 191 patients, RLS-3 patients made comparatively fewer gains in skills from the first to the last evaluation in the cognitive and language domains (both p<0.05).
Conclusions: Class 3 patients are at increased risk for ND delay, warranting closer ND follow-up and greater developmental support for cognitive, communication, and motor skills.


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