186: Frequency and Potentially Modifiable Predictors of Major Neuromotor Disability Following Complex Cardiac Surgery in Early Infancy
Bibliographic record
Abstract
Survival rates after neonatal Complex Cardiac Surgery (CCS) for congenital heart disease (CHD) have increased. Surviving children face neurodevelopmental and neuromotor challenges. While neuro-cognitive difficulties have been reported; little research has been done on motor impairments. Permanent non-progressive motor impairments are cerebral palsy (CP) and acquired brain injury (ABI), including stroke. Major Neuromotor Disability (MND) is the umbrella term used here to include CP and ABI. 1) To calculate the rate of MND among 4.5-year survivors, 2) To describe MND among 4.5-year survivors according to the current CP definition and classification, 3) To determine potentially modifiable acute care predictors that might lead to a reduction in the frequency of MND. This prospective inception cohort study included 549 children with CHD of ≤6 weeks of age at the time of their first CCS requiring cardio-pulmonary bypass at the Stollery Children's Hospital, 1996–2009. Groups included those with only one CCS, mostly bi-ventricular CHD, and those with more than one CCS, predominantly single ventricle defects. After 4.5 years, 105 (19.1%) children had died, 24 (5.4%) were lost to follow up, and 420 survivors received multidisciplinary assessment. The frequency of MND is given as percentage (95% confidence interval [CI]) of assessed survivors. Operative and peri-operative predictors of MND were analyzed using univariate and multiple logistic regression analysis, expressed as odds ratios (OR) with 95% CI. MND occurred in 25 (5.95%) (CI 3.7%, 8.2%) of 420 4.5-year survivors; for one CCS, 4.2%(CI 2.3%, 6.1%) and more than one, 9.8% (CI 7%, 12.6%). MND occurred in 10.3% (CI 7.4%, 13.2%) of those with single ventricle defects. Unilateral MND was found in 18(72%); spasticity in 20(80%). According to the multiple regression model, statistically significant independent OR for MND are: age in days at first surgery, 1.079 (CI: 1.037, 1.123) (P<0.001); and prior to first surgery, highest plasma lactate (mmol/L), 1.129 (CI: 1.032, 1.235) (P=0.008) and highest inotrope score, 1.020 (CI: 0.997, 1.040) (P=0.054) (marginal significance). Adjusting for the presence of these predictors, OR for MND is 3.569 (CI: 1.467, 8.687) (P=0.005) if more than one CCS is needed. MND is not uncommon among survivors after CCS, especially for those children needing more than one surgery. OR for MND is 1.08 for each day the neonatal CCS is delayed and 1.13 for each mmol/L of plasma lactate elevation in the pre-operative period at first surgery. Identification of these potentially modifiable predictors may assist in reducing the frequency of MND after life-saving CCS. This information will improve counselling for families of these children.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".