Neurological evaluation of 3-4 year old patients who underwent cardiac surgery in the neonatal period

ABSTRACT Neurological Evaluation of 3-4 Year Old Patients Who Underwent Cardiac Surgery in the Neonatal Period Objective: Antenatal diagnosis of neonatal congenital heart disease, postnatal follow-up and post-operative follow-up in experienced centers may be useful to avoid long-term complications. We aimed to investigate the cardiac functions, neurological examinations and neurodevelopmental status, growth and development of 3-4-year-old operated congenital cardiac patients in the Neonatal Intensive Care Unit of Cukurova University Medical Faculty Hospital. Material and Method: 25 infants with congenital heart disease who were operated on and followed up between January 2013 and December 2015 at the ÇUFoM NICU were included in the study. Cardiac functions, neurological examinations, Denver Developmental Screening Test II (DGTT II) and Stanford-Binet test were used to evaluate the neurodevelopmental status of the participants. The following information was saved from these infants' epicrisis information retrospectively; demographic characteristics, date of birth, gestational week, sex, birth weight, types of operations, preoperative and postoperative sepsis history, presence and duration of pre- and postoperative ventilator supportive treatments, postoperative inotropic needs, postoperative complications, enteral feeding time, prognosis, and hospitalization durations. Findings: Seven of the patients (28%) had preoperative sepsis. Patients with abnormal DGTT II evaluation had a higher rate of history of sepsis before the operation, and this difference was statistically significant (p=0,032). 8 of the patients (32%) had a need for diuretics at 3-4 years of age. The DGTT II result of patients who needed diuretics was compared with those who didn't and statistically significant low borderline significance was found (p=0,059. The Stanford-Binet test results of the patients who were diagnosed with sepsis before the operation were significantly lower than the patients without sepsis (p=0,007). The patients with a higher gestational age at birth and higher birth weight were found to have lower weight, height and head circumference at 3-4 years of age (p=0,034) (p=0,034) (p=0,031). Conclusion: The occurrence of sepsis attacks before the operation affects the neurological development of the patients with congenital heart disease. Therefore, it is important for patients to take precautionary measures to reduce sepsis prior to the operation, to be informed about this issue when being discharged in order for this to be noticed at an early stage, and to initiate neurological support in a timely manner. The need for cardiologic medical support at 3-4 years of age is also a parameter that should be considered in terms of neurological sequelae development. The gestational week at birth and better birth weight may affect attitudes and the care provided by families. Children who were born at lower gestational weeks and with lower weight may have improved weight as a result of better care and nutrition until 3-4 years of age. Keywords: Newborns, Postcardiac Surgery, Neurological Development