Medical & Socioeconomic Risk Factors Associated with Lack of Neurodevelopmental Evaluation Following Neonatal Cardiac Surgery.

Abstract

Neonates with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB) are at high-risk for unfavorable neurodevelopmental (ND) outcomes and are recommended for ND evaluation (NDE); however, poor rates have been reported. We aimed to identify risk factors associated with lack of NDE. This single-center retrospective observational study included neonates < 30 days old who underwent CPB and survived to discharge between 2012 and 2018. Primary outcome (NDE) was ≥ 1 appointment at our center's dedicated cardiac, neonatal, or general ND clinics before the 3rd birthday. Predictor variables included demographic, medical, and social factors. Social disorganization index (SDI) was obtained with geocoding based on address at time of discharge. Logistic regression identified risk factors associated with lack of NDE. The cohort included 594 patients, predominantly male (59%) and white (59%). A majority (63%) had NDE. Lack of NDE was more common in patients with postnatal CHD diagnosis, CHD without arch obstruction, absence of postoperative seizures, living below 100% poverty level, lack of insurance, younger parental age, and overall higher SDI (p < 0.03). In multivariable analysis, lack of NDE was associated with single-ventricle CHD without arch obstruction (OR 2.17; 95% CI 1.08-4.55), two ventricle CHD without arch obstruction (OR 2.56; 95% CI 1.59-4.17), and higher SDI (OR 1.25; 95% CI 1.05-1.49); all p < 0.05. This study identifies medical and neighborhood-level socioeconomic factors that may help address care gaps in this high-risk population. Patients with socioeconomic disparities may benefit from increased care coordination upon discharge.