The Bayley-III scale may underestimate neurodevelopmental disability after cardiac surgery in infants

Andrew B Goldstone; Michael Baiocchi; David Wypij; Christian Stopp; Dean B Andropoulos; Joseph Atallah; Andrew M Atz; John Beca; Mary T Donofrio; Kim Duncan; Nancy S Ghanayem; Caren S Goldberg; Hedwig Hövels-Gürich; Fukiko Ichida; Jeffrey P Jacobs; Robert Justo; Beatrice Latal; Jennifer S Li; William T Mahle; Patrick S McQuillen; Shaji C Menon; Nancy A Pike; Christian Pizarro; Lara S Shekerdemian; Anne Synnes; Ismée A Williams; David C Bellinger; Jane Newburger; J William Gaynor

doi:10.1093/ejcts/ezz123

The Bayley-III scale may underestimate neurodevelopmental disability after cardiac surgery in infants

Eur J Cardiothorac Surg. 2020 Jan 1;57(1):63-71. doi: 10.1093/ejcts/ezz123.

Authors

Andrew B Goldstone¹, Michael Baiocchi², David Wypij³, Christian Stopp³, Dean B Andropoulos⁴, Joseph Atallah⁵, Andrew M Atz⁶, John Beca⁷, Mary T Donofrio⁸, Kim Duncan⁹, Nancy S Ghanayem¹⁰, Caren S Goldberg¹¹, Hedwig Hövels-Gürich¹², Fukiko Ichida¹³, Jeffrey P Jacobs¹⁴, Robert Justo¹⁵, Beatrice Latal¹⁶, Jennifer S Li¹⁷, William T Mahle¹⁸, Patrick S McQuillen¹⁹, Shaji C Menon²⁰, Nancy A Pike²¹, Christian Pizarro²², Lara S Shekerdemian²³, Anne Synnes²⁴, Ismée A Williams²⁵, David C Bellinger³, Jane Newburger³, J William Gaynor¹

Affiliations

¹ Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
² Stanford University, Stanford, CA, USA.
³ Boston Children's Hospital, Boston, MA, USA.
⁴ Texas Children's Hospital, Houston, TX, USA.
⁵ Stollery Children's Hospital, Western Canadian Complex Pediatric Therapies Follow-up Program, Edmonton, AB, Canada.
⁶ Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA.
⁷ Starship Children's Hospital, Auckland, New Zealand.
⁸ Children's National Medical Center, Washington, DC, USA.
⁹ Children's Hospital and Medical Center, Omaha, NE, USA.
¹⁰ Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
¹¹ Mott's Children's Hospital, Ann Arbor, MI, USA.
¹² University Hospital Aachen, Aachen, Germany.
¹³ Toyama University Hospital, Toyama, Japan.
¹⁴ Johns Hopkins All Children's Heart Institute, St. Petersburg, FL, USA.
¹⁵ University of Queensland, Brisbane, Australia.
¹⁶ University Children's Hospital Zurich, Zurich, Switzerland.
¹⁷ Duke University Medical Center, Durham, NC, USA.
¹⁸ Children's Healthcare of Atlanta, Atlanta, GA, USA.
¹⁹ University of California, San Francisco, CA, USA.
²⁰ Primary Children's Medical Center, Salt Lake City, UT, USA.
²¹ Children's Hospital Los Angeles, Los Angeles, CA, USA.
²² Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
²³ The Royal Children's Hospital, Melbourne, Australia.
²⁴ University of British Columbia, Vancouver, BC, Canada.
²⁵ New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY, USA.

PMID: 31006006
DOI: 10.1093/ejcts/ezz123

Abstract

Objectives: Neurodevelopmental disability is the most common complication among congenital heart surgery survivors. The Bayley scales are standardized instruments to assess neurodevelopment. The most recent edition (Bayley Scales of Infant and Toddler Development 3rd Edition, Bayley-III) yields better-than-expected scores in typically developing and high-risk infants than the second edition (Bayley Scales of Infant Development 2nd Edition, BSID-II). We compared BSID-II and Bayley-III scores in infants undergoing cardiac surgery.

Methods: We evaluated 2198 infants who underwent operations with cardiopulmonary bypass between 1996 and 2009 at 26 institutions. We used propensity score matching to limit confounding by indication in a subset of patients (n = 705).

Results: Overall, unadjusted Bayley-III motor scores were higher than BSID-II Psychomotor Development Index scores (90.7 ± 17.2 vs 77.6 ± 18.8, P < 0.001), and unadjusted Bayley-III composite cognitive and language scores were higher than BSID-II Mental Development Index scores (92.0 ± 15.4 vs 88.2 ± 16.7, P < 0.001). In the propensity-matched analysis, Bayley-III motor scores were higher than BSID-II Psychomotor Development Index scores [absolute difference 14.1, 95% confidence interval (CI) 11.7-17.6; P < 0.001] and the Bayley-III classified fewer children as having severe [odds ratio (OR) 0.24; 95% CI 0.14-0.42] or mild-to-moderate impairment (OR 0.21; 95% CI 0.14-0.32). The composite of Bayley-III cognitive and language scores was higher than BSID-II Mental Development Index scores (absolute difference 4.0, 95% CI 1.4-6.7; P = 0.003), but there was no difference between Bayley editions in the proportion of children classified as having severe cognitive and language impairment.

Conclusions: The Bayley-III yielded higher scores than the BSID-II and classified fewer children as severely impaired. The systematic bias towards higher scores with the Bayley-III precludes valid comparisons between early and contemporary cardiac surgery cohorts.

Keywords: Congenital heart surgery; Neurodevelopment; Propensity score matching.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Surgical Procedures* / adverse effects
Cardiopulmonary Bypass
Child
Child Development
Developmental Disabilities* / diagnosis
Developmental Disabilities* / epidemiology
Developmental Disabilities* / etiology
Humans
Infant