Prevalence and Risk Factors for Cerebral Palsy in Children With Congenital Heart Disease Based on Risk of Surgical Mortality

Suman Ghosh; Ing Grace Lien; Kerstin Martinez; Tracy Lin; Mark S Bleiweis; Joseph Philip; Lori C Jordan; Steven G Pavlakis

doi:10.1016/j.pediatrneurol.2024.02.011

Prevalence and Risk Factors for Cerebral Palsy in Children With Congenital Heart Disease Based on Risk of Surgical Mortality

Pediatr Neurol. 2024 Mar 1:155:133-140. doi: 10.1016/j.pediatrneurol.2024.02.011. Online ahead of print.

Authors

Suman Ghosh¹, Ing Grace Lien², Kerstin Martinez³, Tracy Lin⁴, Mark S Bleiweis⁵, Joseph Philip⁵, Lori C Jordan⁶, Steven G Pavlakis⁷

Affiliations

¹ State University of New York at Downstate Health Sciences University, Brooklyn, New York; Department of Neurology, New York City Health and Hospitals Corporation Kings County Hospital, Brooklyn, New York. Electronic address: suman.ghosh@downstate.edu.
² Department of Neurology, University of Florida, Gainesville, Florida.
³ Herbert Wertheim College of Engineering, University of Florida, Gainesville, Florida.
⁴ College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida.
⁵ University of Florida Health Congenital Heart Center, Gainesville, Florida.
⁶ Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
⁷ State University of New York at Downstate Health Sciences University, Brooklyn, New York; Department of Neurology, New York City Health and Hospitals Corporation Kings County Hospital, Brooklyn, New York.

PMID: 38640862
DOI: 10.1016/j.pediatrneurol.2024.02.011

Abstract

Background: Children with congenital heart disease (CHD) have a higher prevalence of motor impairment secondary to brain injury, resulting in cerebral palsy (CP). The purpose of this study is to determine the prevalence of CP in CHD in a single-center cohort, stratify risk based on surgical mortality using Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) categories and identify risk factors.

Methods: Retrospective cohort study of pediatric patients registered in the University of Florida (UF) Society of Thoracic Surgeons Congenital Heart Surgery database from 2006 to 2017 with a diagnosis of CHD who continued follow-up for more than two years at UF.

Results: A total of 701 children with CHD met inclusion criteria. Children identified to have CP were 54 (7.7%). Most common presentation was spastic hemiplegic CP with a Gross Motor Function Classification System of level 2. Analysis of surgical and intensive care factors between the two groups showed that children with CHD and CP had longer time from admission to surgery (P = 0.003), higher STAT categories 4 and 5 (P = 0.038), and higher frequency of brain injury and seizures (P < 0.001). Developmental disabilities and rehabilitation needs were significantly greater for children with CHD and CP when compared with those with CHD alone (P < 0.001).

Conclusions: In our cohort, 7.7% children with CHD develop CP; this is significantly higher than the 2010 US population estimate of 0.3%. Our study suggests higher STAT categories, brain injury, and seizures are associated with developing CP in children with CHD.

Keywords: Brain injury; Cardiac surgery; Disabilities; Motor impairment; Neurodevelopment; Neurodevelopmental disabilities; STAT.