Preschool Neurodevelopmental Outcomes in Children with Congenital Heart Disease

Abstract

Objective To describe preschool neurodevelopmental outcomes of children with complex congenital heart disease (CHD), who were evaluated as part of a longitudinal cardiac neurodevelopmental follow-up program, as recommended by the American Heart Association and the American Academy of Pediatrics, and identify predictors of neurodevelopmental outcomes in these children. Study design Children with CHD meeting the American Heart Association/American Academy of Pediatrics high-risk criteria for neurodevelopmental delay were evaluated at 4–5 years of age. Testing included standardized neuropsychological measures. Parents completed measures of child functioning. Scores were compared by group (single ventricle [1V]; 2 ventricles [2V]; CHD plus known genetic condition) to test norms and classified as: normal (within 1 SD of mean); at risk (1–2 SD from mean); and impaired (>2 SD from mean). Results Data on 102 patients were analyzed. Neurodevelopmental scores did not differ based on cardiac anatomy (1V vs 2V); both groups scored lower than norms on fine motor and adaptive behavior skills, but were within 1 SD of norms. Patients with genetic conditions scored significantly worse than 1V and 2V groups and test norms on most measures. Conclusions Children with CHD and genetic conditions are at greatest neurodevelopmental risk. Deficits in children with CHD without genetic conditions were mild and may not be detected without formal longitudinal testing. Parents and providers need additional education regarding the importance of developmental follow-up for children with CHD.

Functional limitations and educational needs among children and adolescents with heart disease

“…Researchers have found delayed language development in toddlers with CHD, compared to population means, which might be due to decreased brain white matter volume . Delays in gross and fine motor development have also been reported more commonly in toddlers and young children with CHD compared to healthy controls, siblings/twins, and population norms. Delays in motor skills have been associated with longer cumulative hospital stays, younger gestational age at birth, univentricular CHD anatomy, and genetic or extracardiac anomalies .…”

Neurodevelopmental outcomes at 2 and 4 years in children with congenital heart disease

“…Because of the high prevalence of these deficits, and their impact on quality of life, the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) now recommend systematic evaluation of development in children with CHD throughout childhood to promote early detection of delays and optimize outcomes . Cardiac centers have begun to incorporate developmental follow‐up programs as part of routine cardiac care . However, few centers have reported outcomes for patients seen in these programs, and little is known about whether early developmental evaluations performed in these clinics can predict later outcomes.…”

Neurodevelopmental and health‐related quality‐of‐life outcomes in adolescence after surgery for congenital heart disease in infancy

“…14,15 Early insult to the brain may impair networks that are less likely to affect lower-level skills and functions that emerge in infancy but that are essential for the integration of neural functions that occurs in later development. [18][19][20] While adverse neurodevelopmental outcomes for young children with CHD have been reported, 13,21,22 fewer studies have evaluated later impact using a comprehensive battery of tests, including both clinical measures and self-and proxy-report measures of executive function. 17 Family risk factors, such as parent psychological well-being, perceptions of impairment, and attachment, may also directly influence neurodevelopment, or interact with neurological injuries over time to increase impairment.…”