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Cardiac surgery and the brain: differences between adult and paediatric studies
  1. D C Bellinger
  1. Correspondence to:
    David C Bellinger, PhD, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Farley Basement Box 127, Boston MA 02115, USA;

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Evidence is growing that patients with congenital heart disease who undergo surgery may be at increased risk of neurodevelopmental dysfunctions, particular paediatric survivors. However, paediatric studies involve different challenges from those conducted on adults

In this issue, Dittrich and colleagues1 report a study examining neurodevelopmental outcomes at one year of age in children with congenital heart defects who underwent reparative or palliative surgery in infancy. It adds to the burgeoning literature suggesting that such patients are at increased risk of adverse sequelae. Similar studies have been reported on patients who underwent cardiac surgery as adults, but it is important to note that paediatric studies involve a different set of challenges, involving the study designs that can be implemented, the statistical analyses required, and the inferences that investigators draw.

Studies of adult patients often involve administration of the same neuropsychological battery before surgery and again, sometimes repeatedly, over a follow up interval of weeks to years.2 Having each patient thus serve as his or her own control pays dividends in terms of statistical power, insofar as use of change scores effectively removes the variability in test scores that reflects between-patient differences in factors that affect overall level of performance (for example, education, sex, age). Considerable attention has therefore been devoted to determining valid methods for identifying a significant change in performance (for example, the reliable change index, a decline of …

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