Risk Factors for Abnormal Developmental Trajectories in Young Children With Congenital Heart Disease

Abstract

Background Children with congenital heart disease (CHD) are at risk for developmental delay (DD). This study sought to identify early risk factors for abnormal developmental trajectories in children with CHD. Methods and Results Children with CHD at high risk for DD, without known genetic abnormality, and with ≥3 assessments using the Bayley Scales of Infant Development-III (BSID-III) were studied. Logistic regression was used to assess the impact of patient and clinical factors on cognitive, language, and motor score trajectories; classified as: “Average or Improved” if all scores were ≥ 85 (< 1SD below mean) or increased to ≥ 85 and never decreased; or “Abnormal” if all scores were < 85, fell to < 85 and never improved, or fluctuated above and below 85. Data on 131 children with 527 BSID-III assessments were analyzed. Subject age was 5.5–37.4 months. Overall, 56% had cognitive, language, and motor development in the average range. Delays occurred in single domains in 23%. Multiple domains were delayed in 21%. More cardiac surgeries, longer hospital stay, poorer linear growth, and tube feeding were associated with worse outcomes in all domains (p<0.05). In the multivariable model, need for tube feeding was a risk factor for having an abnormal developmental trajectory (OR = 5.1–7.9). Minority race and lack of private insurance had significant relationships with individual domains. Conclusions Longitudinal developmental surveillance identified early factors that can help quantify risk of DD over time. Strategies to improve modifiable factors and early therapeutic intervention can be targeted to children at highest risk.

Preschool Neurodevelopmental Outcomes in Children with Congenital Heart Disease

“…It was surprising that males did worse on fine motor and prespelling skills, as sex was not found to be a risk factor in our previous studies. 10,16,18 However, findings of the current study are consistent with recent reports that have shown similar differences by sex in motor and writing skills in healthy children. 35,36 It is interesting to note that no factors examined in the present study predicted problems with executive functioning, attention, or behavior, deficits that are frequently seen in older children with CHD.…”

“…Eligibility criteria and operation of the Herma Heart Center Developmental Follow-Up Clinic have been previously described. 10,16,18 Children were deemed to be at high risk for developmental delay and eligible for the clinic if they had any cardiac surgery as a neonate, surgery using cardiopulmonary bypass (CPB) in the first year of life, a cardiac defect resulting in cyanosis, or other comorbid conditions or complications such as prematurity, genetic syndromes, seizures, or cardiac arrest that placed them at higher risk for delay. Genetic testing was used to confirm a diagnosis when a genetic syndrome was suspected, but all patients did not routinely undergo genetic testing.…”

“…16,17 We have previously reported developmental outcomes of children who were evaluated in our longitudinal developmental follow-up program over the first 3 years of life and found that 46% of patients were delayed in at least 1 domain (cognitive, language, or motor skills); feeding difficulty and medical and genetic comorbidities increased risk for delays. 10,18 The aim of this study was to summarize and identify predictors of neurodevelopmental outcomes for preschoolers who were seen as part of a longitudinal developmental evaluation program for children with CHD.…”

Predictors of Memory Deficits in Adolescents and Young Adults with Congenital Heart Disease Compared to Healthy Controls

“…However, the size and significance of the beta coefficient for the variable number of surgeries suggest that surgery may have a greater impact on memory. The number of surgeries has been reported in other studies to be predictive of abnormal developmental outcomes in younger children (39) or for internalizing (anxiety/depression) and externalizing (attentional disorders) behavior problem in CHD (40). Utens and colleagues (40) also found the number of surgeries to be predictive of behavioral problems and suggested that the number of surgeries, procedures, or hospitalizations could potentially reflect the “experiential” aspect of living with CHD.…”

White Matter Volume Predicts Language Development in Congenital Heart Disease

“…3-6 Language in particular was the most common isolated delay in one longitudinal study of children with CHD. 7 In biventricular forms of CHD, such as transposition of the great arteries (TGA) or tetralogy of Fallot (TOF), over half of children require special services such as special education or early intervention. 4, 8 Thus, neurodevelopmental impairments significantly influence quality of life and daily functioning.…”