Prematurity Predicts Neurodevelopmental Outcomes in Congenital Heart Disease

BACKGROUND: Neurodevelopmental impairment is common in both prematurity and congenital heart disease (CHD). Preterm infants with CHD may have a "double hit," with worse neurodevelopmental impairments than seen in prematurity or CHD alone. METHODS: This single-center retrospective cohort study included children with CHD who underwent cardiac surgery in infancy (2007-2020) and completed neurodevelopmental testing. Using the Bayley Scales of Infant and Toddler Development, Third Edition, we assessed cognitive, language, and motor outcomes. Patients were stratified by gestational age: extremely/very/moderately preterm (≤33 weeks), late-preterm (34-36 weeks), early-term (37-38 weeks), or term/postterm (≥39 weeks). Multivariable linear regression was used to model Bayley scores, adjusting for demographic, medical, and surgical covariates. RESULTS: Among 1350 infants who underwent cardiac surgery, 513 (38%) completed Bayley scale assessment at median age 28 months (interquartile range, 19-34). 448 (87%) were full term and 65 (13%) preterm. After multivariable adjustment, gestational age remained a significant independent predictor of cognitive and motor scores. Children born ≤33 weeks had the worst outcomes, with age-adjusted cognitive and motor composite scores 11 (95% CI, 5-17) and 15 (95% CI, 8-22) points lower, respectively, than those born at term. Other significant predictors included lower caregiver education, Black race, longer hospitalization, and genetic diagnosis. These models explained 17% to 26% of the variance in Bayley scores. The highest explained variance was in the motor domain. CONCLUSIONS: Prematurity is a significant risk factor for adverse cognitive and motor outcomes in children with CHD, especially in those born ≤33 weeks. Enhanced neurodevelopmental surveillance and targeted early intervention strategies are warranted for this vulnerable population.