PREDICTORS OF DEVELOPMENTAL OUTCOMES IN CHILDREN WITH COMPLETE TRANSPOSITION

Cognitive, functional, educational achievement and behavioural measure s were employed to assess neurobehavioral status in 57 of 60 participa nts who were initially enrolled in the Baltimore-Washington Infant Stu dy, and who survived surgical correction of complete transposition (co ncordant atrioventricular and discordant ventriculo-arterial connectio ns). Charts were reviewed to investigate the relationship between birt h variables, surgical strategy and developmental outcomes. Higher preo perative weight was associated with better outcomes on the Stanford-Bi net Short-term Memory subtest, while lower preoperative oxygen tension was associated with better outcomes on the Abstract/Visual Reasoning subtest and a test of Visual-Motor Integration. Longer total bypass ti me was associated with poor outcomes on the Short-term Memory subtests . Higher average flow rates during cooling and rewarming were associat ed with higher scores in the test of short term memory but poorer outc omes on a test for visual motor integration. Longer cooling times were associated with higher scores on the test for Visual-Motor Integratio n. Patients suffering seizures scored lower on the Stanford-Binet Comp osite, as well as in their tests of achievement. The data indicate tha t non-verbal skills may be particularly sensitive to variations in sur gical strategies employed to correct complete transposition. Overt neu rological events, such as seizures, were related to global deficits in intellectual functioning. Prospective studies evaluating systemic var iations in surgical procedures and attempts to prevent and manage peri operative neurological events are important for further investigation of neurodevelopmental outcomes in children surviving surgical correcti on.