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Published in: Pediatric Cardiology 2/2013

01-02-2013 | Original Article

A Predictive Model for Neurodevelopmental Outcome After the Norwood Procedure

Authors: William T. Mahle, Minmin Lu, Richard G. Ohye, J. William Gaynor, Caren S. Goldberg, Lynn A. Sleeper, Victoria L. Pemberton, Kathleen A. Mussatto, Ismee A. Williams, Erica Sood, Catherine Dent Krawczeski, Alan Lewis, Nicole Mirarchi, Mark Scheurer, Sara K. Pasquali, Nelangi Pinto, Jeffrey P. Jacobs, Brian W. McCrindle, Jane W. Newburger

Published in: Pediatric Cardiology | Issue 2/2013

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Abstract

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.
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Metadata
Title
A Predictive Model for Neurodevelopmental Outcome After the Norwood Procedure
Authors
William T. Mahle
Minmin Lu
Richard G. Ohye
J. William Gaynor
Caren S. Goldberg
Lynn A. Sleeper
Victoria L. Pemberton
Kathleen A. Mussatto
Ismee A. Williams
Erica Sood
Catherine Dent Krawczeski
Alan Lewis
Nicole Mirarchi
Mark Scheurer
Sara K. Pasquali
Nelangi Pinto
Jeffrey P. Jacobs
Brian W. McCrindle
Jane W. Newburger
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Pediatric Cardiology / Issue 2/2013
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-012-0450-1

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