Growth and risk of adverse neuro‐developmental outcome in infants with congenital heart disease: A systematic review

Abstract

Aim Congenital heart disease (CHD) is one of the most common birth defects affecting around 1:100 infants. In this systematic review, we aimed to determine impact of growth on neurodevelopmental outcomes of infants with CHD. Methods Studies that reported association of growth with developmental outcomes in infants with CHD who had surgery, were included. The search strategy was prospectively registered. Relevant studies were identified by electronic searches. The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched from their earliest date to February 2022. Results Twenty studies met inclusion criteria. Choice of growth measures, developmental assessment tools and timing of assessment varied widely precluding conduct of a meta‐analysis. Seventeen studies reported on infants who had cardio‐pulmonary bypass. Birth weight was reported in thirteen studies and was associated with adverse outcome in nine. Head circumference at birth and later predicted developmental outcomes in five. Impaired postnatal growth was associated with adverse developmental outcome in seven studies. Conclusion Growth in infants with congenital heart disease, specifically single ventricle physiology can predict adverse neurodevelopmental outcome. Included studies showed significant clinical heterogeneity. Uniformity should be agreed by various data registries with routine prospective collection of growth and developmental data.

Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association

“…63 Lower weight at the time of infant cardiac surgery has also been associated with worse developmental test scores. 63 In addition, poorer linear growth and smaller head circumference in infancy and toddlerhood have been associated with worse neurodevelopment outcomes for children with congenital heart disease.…”

“…Individuals who require an intervention or hospitalization secondary to congenital heart disease during infancy, childhood, or adolescence and do not meet criteria for Risk Categories 1 or 2 may still be at increased risk for developmental delay or disorder on the basis of their genetic, medical, surgical, perioperative, and social histories. Many factors that increase neurodevelopmental risk (Figure 1) have a heightened prevalence within the congenital heart disease population because of high rates of genetic syndromes, 17 growth abnormalities, 63 feeding issues, 64 medical and surgical complications, 21 and parental psychological distress. 23…”

“…63 Lower weight at the time of infant cardiac surgery has also been associated with worse developmental test scores. 63 In addition, poorer linear growth and smaller head circumference in infancy and toddlerhood have been associated with worse neurodevelopment outcomes for children with congenital heart disease. 12,113–115 Although clear cutoffs for weight-for-age Z scores, length-for-age Z scores, or head circumference-for-age Z scores have not yet been determined for poor neurodevelopmental outcomes, a history of growth failure in infancy or toddlerhood is associated with worse neurodevelopmental outcomes for individuals with congenital heart disease.…”

“…12,14,113,114 Growth Failure in Infancy or Toddlerhood Growth failure is common in infants and young children with congenital heart disease. 63 A recent systematic review examining the impact of growth on neurodevelopmental outcomes in infants with congenital heart disease reported that poor growth in utero, as measured by weight and head circumference at birth, has been associated with worse neurodevelopmental outcomes, and being small for gestational age predicted lower IQ and communication skills. 63 Lower weight at the time of infant cardiac surgery has also been associated with worse developmental test scores.…”

Somatic growth in congenital heart disease—A balance between genetic potential and treatment effects

“…Growth during infancy in children with CHD has welldocumented predictive power in terms of long-term prognosis. 1,3,4 In the October issue of Acta Paediatrica, Trivedi et al 5 presented their systematic review on somatic growth in infants with congenital heart disease and its impact on neurodevelopmental outcomes. Both low birth weight, head circumference and postnatal growth were adversely correlated to developmental outcome.…”