human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVES : Little is known about chronic neuromotor disability ( CND ) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery ( CCS ) . We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors . METHODS : This prospect i ve follow-up study included 549 children after CCS requiring cardiopulmonary bypass at ≤6 weeks of age . Groups included those with only 1 CCS , mostly biventricular CHD , and those with > 1 CCS , predominantly single ventricle defects . At 4.5 years of age , 420 ( 94.6 % ) children received multidisciplinary assessment .  Frequency of CND is given as percentage of assessed survivors . Predictors of CND were analyzed using multiple logistic regression analysis . RESULTS : CND occurred in 6 % ( 95 % confidence interval [ CI ] 3.7%–8.2 % ) of 4.5-year survivors ; for 1 CCS , 4.2 % ( CI 2.3%–6.1 % ) and > 1 , 9.8 % ( CI 7%–12.6 % ) . CND presentation showed : hemiparesis , 72 % ; spasticity , 80 % ; ambulation , 72 % ; intellectual disability , 44 % ; autism , 16 % ; epilepsy , 12 % ; permanent vision and hearing impairment , 12 % and 8 % , respectively . Overall , 32 % of presumed causative events happened before first CCS . Independent odds ratio for CND are age ( days ) at first CCS , 1.08 ( CI 1.04–1.12 ; P < .001 ) ; highest plasma lactate before first CCS ( mmol/L ) , 1.13 ( CI 1.03–1.23 ; P = 0.008 ) ; and > 1 CCS , 3.57 ( CI 1.48–8.9 ; P = .005 ) . CONCLUSIONS : CND is not uncommon among CCS survivors . The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population . Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND BACKGROUND It is not known whether developmental and neurological outcomes in the preschool period differ depending on whether the predominant vital organ support strategy used in infant heart surgery was total circulatory arrest ( CA ) or low-flow cardiopulmonary bypass . METHODS AND RESULTS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a support method consisting predominantly of CA or low-flow cardiopulmonary bypass .  Developmental and neurological status were evaluated blindly at 4 years of age in 158 of 163 eligible children ( 97 % ) . Neither IQ scores nor overall neurological status were significantly associated with either treatment group or duration of CA . The CA group scored lower on tests of motor function ( gross motor , P=0.01 ; fine motor , P=0.03 ) and had more severe speech abnormalities ( oromotor apraxia , P=0.007 ) . Seizures in the perioperative period , detected either clinical ly or by continuous electroencephalographic monitoring , were associated with lower mean IQ scores ( 12.6 and 7.7 points , respectively ) and increased risk of neurological abnormalities ( odds ratios , 8.4 and 5.6 , respectively ) . The performance of the full cohort was below expectations in several domains , including IQ , expressive language , visual-motor integration , motor function , and oromotor control . CONCLUSIONS Use of CA to support vital organs during open heart surgery in infancy is associated , at the age of 4 years , with worse motor coordination and planning but not with lower IQ or with worse overall neurological status Background : It is unknown whether intraoperative hyperglycemia in infants is associated with worse neurodevelopmental outcomes after  low-flow cardiopulmonary bypass ( LF ) , deep hypothermic circulatory arrest ( CA ) , or both . Methods : In a data base review of a prospect i ve trial of 171 infants undergoing arterial switch for D-transposition of the great arteries who were r and omly assigned to predominately LF or CA , glucose was measured after induction ( T1 ) , 5 min after cardiopulmonary bypass onset ( T2 ) , at the onset of CA or LF ( T3 ) , 5 min after CPB resumption ( T4 ) , at rewarming to 32 ° C ( T5 ) , 10 min after cardiopulmonary bypass weaning ( T6 ) , and 90 min after CA or LF ( T7 ) . Outcomes included seizures , electroencephalographic findings , and neurodevelopmental evaluation at 1 , 4 , and 8 yr . Results : Glucose concentrations were affected by support strategy and age at surgery . Lower glucose in the entire group at T6–T7 tended to predict electroencephalographic seizures ( P = 0.06 and P = 0.007 ) but was not related to clinical seizures . Within the predominantly CA group , higher glucose did not correlate with worse outcomes . Rather , it was associated with more rapid electroencephalographic normalization of “ close burst ” and “ relative continuous ” activity at all times except T2 ( P ≤ 0.03 ) , a finding more pronounced in infants aged 7 days old or younger . Intraoperative serum glucose concentrations were unrelated to neurodevelopmental outcomes at ages 1 , 4 , and 8 yr . Conclusions : Low glucose after cardiopulmonary bypass tended to relate to electroencephalographic seizures and slower electroencephalogram recovery , independent of CA duration . High glucose concentrations were not associated with worse neurodevelopmental outcomes . Avoiding hypoglycemia may be preferable to restricting glucose in infants undergoing heart surgery Objective . Studies of developmental outcomes in children with congenital heart disease ( CHD ) frequently use assessment s conducted in infancy as primary endpoints . Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated , however . Methods . In the Boston Circulatory Arrest Study , 135 children with D-transposition of the great arteries repaired by arterial switch operation  were administered the  Bayley Scales of Infant Development  and the Fagan Test of Infant Intelligence  at 1 year of age and the Wechsler Intelligence Scale for Children , Third Edition and the Wechsler Individual Achievement Test at 8 years . Results . Although most 1-year test scores were significantly associated with 8-year test scores , the amounts of shared variance were modest ( < 10 % ) . All 1-year test scores had poor sensitivity ( 16%–32 % ) and poor positive predictive value ( 35%–42 % ) but good specificity ( 80%–93 % ) and negative predictive value ( 78%–79 % ) . More than half of the children with low scores at 8 years ( ≤85 ) had had scores > 84 at 1 year . Conclusion . This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years , many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores . Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative , intraoperative , and postoperative factors BACKGROUND Deep hypothermia with either total circulatory arrest or low-flow cardiopulmonary bypass is used to support vital organs during heart surgery in infants . We compared the developmental and neurologic sequelae of these two strategies one year after surgery . METHODS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a method of support consisting predominantly of circulatory arrest or a method consisting predominantly of low-flow bypass . Developmental and neurologic evaluations and magnetic resonance imaging ( MRI ) were performed at one year of age . RESULTS Of the 171 patients enrolled in the study , 155 were evaluated . After adjustment for the presence or absence of a ventricular septal defect , the infants assigned to circulatory arrest , as compared with those assigned to low-flow bypass , had a lower mean score on the Psychomotor Development Index of the Bayley Scales of Infant Development ( a 6.5-point deficit , P = 0.01 ) and a higher proportion had scores < or = 80 ( i.e. , 2 SD or more below the population mean ) ( 27 percent vs. 12 percent , P = 0.02 ) . The score on the Psychomotor Development Index was inversely related to the duration of circulatory arrest ( P = 0.02 ) . The risk of neurologic abnormalities increased with the duration of circulatory arrest ( P = 0.04 ) . The method of support was not associated with the prevalence of abnormalities on MRI scans of the brain , scores on the Mental Development Index of the Bayley Scale , or scores on a test of visual-recognition memory . Perioperative electroencephalographic seizure activity was associated with lower scores on the Psychomotor Development Index ( P = 0.002 ) and an increased likelihood of abnormalities on MRI scans of the brain ( P < 0.001 ) . CONCLUSIONS Heart surgery performed with circulatory arrest as the predominant support strategy is associated with a higher risk of delayed motor development and neurologic abnormalities at the age of one year than is surgery with low-flow bypass as the predominant support strategy BACKGROUND Truncus arteriosus ( TA ) is an uncommon congenital cardiac lesion that portends an exceedingly poor prognosis if not repaired . The objective of this study was to assess the clinical and developmental outcomes in a prospect i ve cohort of patients who underwent TA repair .  METHODS All patients who underwent a TA repair between 1996 and 2012 were included . Follow-up clinical , neurologic , and developmental data were obtained from the Western Canadian Complex Pediatric Therapies Follow-up Program data base . Functional developmental outcomes were assessed at 21.1 ± 2.5 months of age with the Adaptive Behavior Assessment System-II , General Adaptive Composite ( GAC ) score . Survival and outcomes were compared between those with and without chromosomal abnormalities ( CA ) . Survival and freedom from reintervention were assessed by Kaplan-Meier analysis . RESULTS The study comprised 36 infants ( 19 male ) . CA was identified in 13 , with 22q11.2 deletion in 10 patients . Patients underwent TA repair at a median age of 10 days ; 5 patients underwent concomitant interrupted arch repair . There were 8 deaths , 2 of which occurred in the hospital . The 5-year survival was 79.4 % . Survival was similar between those with and without CA . At 5 years , freedom from reoperation was 77.2 % . The mean GAC was higher in the patients without CA ( 93.6 ± 12.8 vs 76.1 ± 13.1 , p = 0.0016 ) . CONCLUSIONS Patients with surgically repaired TA continue to have significant postoperative mortality . Reoperation and cardiac catheterization are eventualities for a quarter of patients in the first 5 years of life . Functional developmental outcome in patients without CA is good , although it is significantly impaired in those with CA Objectives Neonates with single ventricle congenital heart disease are at risk for structural cerebral abnormalities . Little is known about the further evolution of cerebral abnormalities until Fontan procedure . Methods Between August 2012 and July 2015 , we conducted a prospect i ve cross-sectional two centre study using cerebral magnetic resonance imaging ( MRI ) and neuro-developmental outcome assessed by the Bayley-III . Forty-seven children ( 31 male ) were evaluated at a mean age of 25.9 ± 3.4 months with hypoplastic left heart syndrome ( 25 ) or other single ventricle ( 22 ) . Results  Cerebral MRI  was abnormal in 17 patients ( 36.2 % ) including liquor space enlargements ( 10 ) , small grey ( 9 ) and minimal white ( 5 ) matter injuries . Eight of 17 individuals had combined lesions . Median ( range ) cognitive composite score ( CCS ) ( 100 , 65 - 120 ) and motor composite score ( MCS ) ( 97 , 55 - 124 ) were comparable to the reference data , while language composite score ( LCS ) ( 97 , 68 - 124 ) was significantly lower ( P = 0.040 ) . Liquor space enlargement was associated with poorer performance on all Bayley-III subscores ( CCS : P = 0.02 ; LCS : P = 0.002 ; MCS : P = 0.013 ) . The number of re-operations [ odds ratio ( OR ) 2.2 , 95 % confidence interval ( CI ) 1.1 - 4.3 ] ( P = 0.03 ) and re- interventions ( OR 2.1 , 95 % CI 1.1 - 3.8 ) ( P = 0.03 ) was associated with a higher rate of overall MRI abnormalities . Conclusions Cerebral MRI abnormalities occur in more than one third of children with single ventricle , while the neuro-developmental status is less severely affected before Fontan procedure . Liquor space 
    Output:
    
agent
Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVES : Little is known about chronic neuromotor disability ( CND ) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery ( CCS ) . We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors . METHODS : This prospect i ve follow-up study included 549 children after CCS requiring cardiopulmonary bypass at ≤6 weeks of age . Groups included those with only 1 CCS , mostly biventricular CHD , and those with > 1 CCS , predominantly single ventricle defects . At 4.5 years of age , 420 ( 94.6 % ) children received multidisciplinary assessment .  Frequency of CND is given as percentage of assessed survivors . Predictors of CND were analyzed using multiple logistic regression analysis . RESULTS : CND occurred in 6 % ( 95 % confidence interval [ CI ] 3.7%–8.2 % ) of 4.5-year survivors ; for 1 CCS , 4.2 % ( CI 2.3%–6.1 % ) and > 1 , 9.8 % ( CI 7%–12.6 % ) . CND presentation showed : hemiparesis , 72 % ; spasticity , 80 % ; ambulation , 72 % ; intellectual disability , 44 % ; autism , 16 % ; epilepsy , 12 % ; permanent vision and hearing impairment , 12 % and 8 % , respectively . Overall , 32 % of presumed causative events happened before first CCS . Independent odds ratio for CND are age ( days ) at first CCS , 1.08 ( CI 1.04–1.12 ; P < .001 ) ; highest plasma lactate before first CCS ( mmol/L ) , 1.13 ( CI 1.03–1.23 ; P = 0.008 ) ; and > 1 CCS , 3.57 ( CI 1.48–8.9 ; P = .005 ) . CONCLUSIONS : CND is not uncommon among CCS survivors . The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population . Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND BACKGROUND It is not known whether developmental and neurological outcomes in the preschool period differ depending on whether the predominant vital organ support strategy used in infant heart surgery was total circulatory arrest ( CA ) or low-flow cardiopulmonary bypass . METHODS AND RESULTS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a support method consisting predominantly of CA or low-flow cardiopulmonary bypass .  Developmental and neurological status were evaluated blindly at 4 years of age in 158 of 163 eligible children ( 97 % ) . Neither IQ scores nor overall neurological status were significantly associated with either treatment group or duration of CA . The CA group scored lower on tests of motor function ( gross motor , P=0.01 ; fine motor , P=0.03 ) and had more severe speech abnormalities ( oromotor apraxia , P=0.007 ) . Seizures in the perioperative period , detected either clinical ly or by continuous electroencephalographic monitoring , were associated with lower mean IQ scores ( 12.6 and 7.7 points , respectively ) and increased risk of neurological abnormalities ( odds ratios , 8.4 and 5.6 , respectively ) . The performance of the full cohort was below expectations in several domains , including IQ , expressive language , visual-motor integration , motor function , and oromotor control . CONCLUSIONS Use of CA to support vital organs during open heart surgery in infancy is associated , at the age of 4 years , with worse motor coordination and planning but not with lower IQ or with worse overall neurological status Background : It is unknown whether intraoperative hyperglycemia in infants is associated with worse neurodevelopmental outcomes after  low-flow cardiopulmonary bypass ( LF ) , deep hypothermic circulatory arrest ( CA ) , or both . Methods : In a data base review of a prospect i ve trial of 171 infants undergoing arterial switch for D-transposition of the great arteries who were r and omly assigned to predominately LF or CA , glucose was measured after induction ( T1 ) , 5 min after cardiopulmonary bypass onset ( T2 ) , at the onset of CA or LF ( T3 ) , 5 min after CPB resumption ( T4 ) , at rewarming to 32 ° C ( T5 ) , 10 min after cardiopulmonary bypass weaning ( T6 ) , and 90 min after CA or LF ( T7 ) . Outcomes included seizures , electroencephalographic findings , and neurodevelopmental evaluation at 1 , 4 , and 8 yr . Results : Glucose concentrations were affected by support strategy and age at surgery . Lower glucose in the entire group at T6–T7 tended to predict electroencephalographic seizures ( P = 0.06 and P = 0.007 ) but was not related to clinical seizures . Within the predominantly CA group , higher glucose did not correlate with worse outcomes . Rather , it was associated with more rapid electroencephalographic normalization of “ close burst ” and “ relative continuous ” activity at all times except T2 ( P ≤ 0.03 ) , a finding more pronounced in infants aged 7 days old or younger . Intraoperative serum glucose concentrations were unrelated to neurodevelopmental outcomes at ages 1 , 4 , and 8 yr . Conclusions : Low glucose after cardiopulmonary bypass tended to relate to electroencephalographic seizures and slower electroencephalogram recovery , independent of CA duration . High glucose concentrations were not associated with worse neurodevelopmental outcomes . Avoiding hypoglycemia may be preferable to restricting glucose in infants undergoing heart surgery Objective . Studies of developmental outcomes in children with congenital heart disease ( CHD ) frequently use assessment s conducted in infancy as primary endpoints . Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated , however . Methods . In the Boston Circulatory Arrest Study , 135 children with D-transposition of the great arteries repaired by arterial switch operation  were administered the  Bayley Scales of Infant Development  and the Fagan Test of Infant Intelligence  at 1 year of age and the Wechsler Intelligence Scale for Children , Third Edition and the Wechsler Individual Achievement Test at 8 years . Results . Although most 1-year test scores were significantly associated with 8-year test scores , the amounts of shared variance were modest ( < 10 % ) . All 1-year test scores had poor sensitivity ( 16%–32 % ) and poor positive predictive value ( 35%–42 % ) but good specificity ( 80%–93 % ) and negative predictive value ( 78%–79 % ) . More than half of the children with low scores at 8 years ( ≤85 ) had had scores > 84 at 1 year . Conclusion . This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years , many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores . Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative , intraoperative , and postoperative factors BACKGROUND Deep hypothermia with either total circulatory arrest or low-flow cardiopulmonary bypass is used to support vital organs during heart surgery in infants . We compared the developmental and neurologic sequelae of these two strategies one year after surgery . METHODS Infants with D-transposition of the great arteries who underwent an arterial-switch operation were r and omly assigned to a method of support consisting predominantly of circulatory arrest or a method consisting predominantly of low-flow bypass . Developmental and neurologic evaluations and magnetic resonance imaging ( MRI ) were performed at one year of age . RESULTS Of the 171 patients enrolled in the study , 155 were evaluated . After adjustment for the presence or absence of a ventricular septal defect , the infants assigned to circulatory arrest , as compared with those assigned to low-flow bypass , had a lower mean score on the Psychomotor Development Index of the Bayley Scales of Infant Development ( a 6.5-point deficit , P = 0.01 ) and a higher proportion had scores < or = 80 ( i.e. , 2 SD or more below the population mean ) ( 27 percent vs. 12 percent , P = 0.02 ) . The score on the Psychomotor Development Index was inversely related to the duration of circulatory arrest ( P = 0.02 ) . The risk of neurologic abnormalities increased with the duration of circulatory arrest ( P = 0.04 ) . The method of support was not associated with the prevalence of abnormalities on MRI scans of the brain , scores on the Mental Development Index of the Bayley Scale , or scores on a test of visual-recognition memory . Perioperative electroencephalographic seizure activity was associated with lower scores on the Psychomotor Development Index ( P = 0.002 ) and an increased likelihood of abnormalities on MRI scans of the brain ( P < 0.001 ) . CONCLUSIONS Heart surgery performed with circulatory arrest as the predominant support strategy is associated with a higher risk of delayed motor development and neurologic abnormalities at the age of one year than is surgery with low-flow bypass as the predominant support strategy BACKGROUND Truncus arteriosus ( TA ) is an uncommon congenital cardiac lesion that portends an exceedingly poor prognosis if not repaired . The objective of this study was to assess the clinical and developmental outcomes in a prospect i ve cohort of patients who underwent TA repair .  METHODS All patients who underwent a TA repair between 1996 and 2012 were included . Follow-up clinical , neurologic , and developmental data were obtained from the Western Canadian Complex Pediatric Therapies Follow-up Program data base . Functional developmental outcomes were assessed at 21.1 ± 2.5 months of age with the Adaptive Behavior Assessment System-II , General Adaptive Composite ( GAC ) score . Survival and outcomes were compared between those with and without chromosomal abnormalities ( CA ) . Survival and freedom from reintervention were assessed by Kaplan-Meier analysis . RESULTS The study comprised 36 infants ( 19 male ) . CA was identified in 13 , with 22q11.2 deletion in 10 patients . Patients underwent TA repair at a median age of 10 days ; 5 patients underwent concomitant interrupted arch repair . There were 8 deaths , 2 of which occurred in the hospital . The 5-year survival was 79.4 % . Survival was similar between those with and without CA . At 5 years , freedom from reoperation was 77.2 % . The mean GAC was higher in the patients without CA ( 93.6 ± 12.8 vs 76.1 ± 13.1 , p = 0.0016 ) . CONCLUSIONS Patients with surgically repaired TA continue to have significant postoperative mortality . Reoperation and cardiac catheterization are eventualities for a quarter of patients in the first 5 years of life . Functional developmental outcome in patients without CA is good , although it is significantly impaired in those with CA Objectives Neonates with single ventricle congenital heart disease are at risk for structural cerebral abnormalities . Little is known about the further evolution of cerebral abnormalities until Fontan procedure . Methods Between August 2012 and July 2015 , we conducted a prospect i ve cross-sectional two centre study using cerebral magnetic resonance imaging ( MRI ) and neuro-developmental outcome assessed by the Bayley-III . Forty-seven children ( 31 male ) were evaluated at a mean age of 25.9 ± 3.4 months with hypoplastic left heart syndrome ( 25 ) or other single ventricle ( 22 ) . Results  Cerebral MRI  was abnormal in 17 patients ( 36.2 % ) including liquor space enlargements ( 10 ) , small grey ( 9 ) and minimal white ( 5 ) matter injuries . Eight of 17 individuals had combined lesions . Median ( range ) cognitive composite score ( CCS ) ( 100 , 65 - 120 ) and motor composite score ( MCS ) ( 97 , 55 - 124 ) were comparable to the reference data , while language composite score ( LCS ) ( 97 , 68 - 124 ) was significantly lower ( P = 0.040 ) . Liquor space enlargement was associated with poorer performance on all Bayley-III subscores ( CCS : P = 0.02 ; LCS : P = 0.002 ; MCS : P = 0.013 ) . The number of re-operations [ odds ratio ( OR ) 2.2 , 95 % confidence interval ( CI ) 1.1 - 4.3 ] ( P = 0.03 ) and re- interventions ( OR 2.1 , 95 % CI 1.1 - 3.8 ) ( P = 0.03 ) was associated with a higher rate of overall MRI abnormalities . Conclusions Cerebral MRI abnormalities occur in more than one third of children with single ventricle , while the neuro-developmental status is less severely affected before Fontan procedure . Liquor space 
    Output:
    