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Author Notes:

Dr. Vicky L. Ng Division of Paediatric Gastroenterology, Hepatology and Nutrition Transplant and Regenerative Medicine Center The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Main: (416) 813-6171, Fax: (416) 813-4972, vicky.ng@sickkids.ca

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Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • PORTAL-VEIN OBSTRUCTION
  • TOTAL SERUM BILIRUBIN
  • GENERAL-ANESTHESIA
  • MOTOR DEVELOPMENT
  • BAYLEY-III
  • INFANTS
  • TRANSPLANTATION
  • CORTICOSTEROIDS
  • DISEASE
  • AGE

Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

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Journal Title:

Journal of Pediatrics

Volume:

Volume 196

Publisher:

, Pages 139-+

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objectives: To assess neurodevelopmental outcomes among participants with biliary atresia with their native liver at ages 12 months (group 1) and 24 months (group 2), and to evaluate variables predictive of neurodevelopmental impairment. Study design: Participants enrolled in a prospective, longitudinal, multicenter study underwent neurodevelopmental testing with either the Bayley Scales of Infant Development, 2nd edition, or Bayley Scales of Infant and Toddler Development, 3rd edition. Scores (normative mean = 100 ± 15) were categorized as ≥100, 85-99, and <85 for χ 2 analysis. Risk for neurodevelopmental impairment (defined as ≥1 score of <85 on the Bayley Scales of Infant Development, 2nd edition, or Bayley Scales of Infant and Toddler Development, 3rd edition, scales) was analyzed using logistic regression. Results: There were 148 children who completed 217 Bayley Scales of Infant and Toddler Development, 3rd edition, examinations (group 1, n = 132; group 2, n = 85). Neurodevelopmental score distributions significantly shifted downward compared with test norms at 1 and 2 years of age. Multivariate analysis identified ascites (OR, 3.17; P =.01) and low length z-scores at time of testing (OR, 0.70; P <.04) as risk factors for physical/motor impairment; low weight z-score (OR, 0.57; P =.001) and ascites (OR, 2.89; P =.01) for mental/cognitive/language impairment at 1 year of age. An unsuccessful hepatoportoenterostomy was predictive of both physical/motor (OR, 4.88; P <.02) and mental/cognitive/language impairment (OR, 4.76; P =.02) at 2 years of age. Conclusion: Participants with biliary atresia surviving with native livers after hepatoportoenterostomy are at increased risk for neurodevelopmental delays at 12 and 24 months of age. Those with unsuccessful hepatoportoenterostomy are >4 times more likely to have neurodevelopmental impairment compared with those with successful hepatoportoenterostomy. Growth delays and/or complications indicating advanced liver disease should alert clinicians to the risk for neurodevelopmental delays, and expedite appropriate interventions.

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© 2018 Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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