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A Neonatal Heterotopic Rat Heart Transplantation Model for the Study of Endothelial-to-Mesenchymal Transition
Published on: July 21, 2023
A longitudinal perspective on neurodevelopmental outcome after infant cardiac transplantation
M Catherin Freier1, Talin Babikian, Jamie Pivonka
1Department of Psychology, Loma Linda University, Loma Linda, CA 92350, USA.
Insights
Pediatric heart transplant recipients showed mild delays in motor development and variable cognitive skills, particularly in speech/language and abstract reasoning. Early intervention is crucial for improving quality of life after infant heart transplantation.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Transplantation Medicine
Background:
- Quality of life is a growing focus in pediatric heart transplantation outcomes.
- Infants undergoing heart transplantation are at risk for neurodevelopmental delays.
- Longitudinal studies on developmental patterns in this population are lacking.
Purpose of the Study:
- To longitudinally assess neurodevelopmental patterns in infants after heart transplantation.
- To identify specific areas of delay and variability in cognitive and motor skills.
- To inform early intervention strategies for improving long-term outcomes.
Main Methods:
- 39 children who received heart transplants before age 1 were assessed using the Bayley Scales of Infant Development-II.
- Assessments were conducted consecutively over time for children aged 2 to 38 months.
- Statistical analyses, including repeated measures ANOVA, were used to evaluate developmental trajectories.
Main Results:
- Mean Mental Development Index (MDI) scores were within normal limits, with mild delays noted between 18-23 and 24-35 months.
- Average Psychomotor Development Index (PDI) scores indicated mild delays across most age groups, except 36-38 months.
- Significant decreases in MDI scores were observed at 18 months and 28-36 months, suggesting age-dependent cognitive variability.
Conclusions:
- Motor development was consistently mildly delayed in this cohort.
- Cognitive development showed age-dependent variability, with specific delays linked to speech/language and abstract reasoning.
- Potential causes for delays include test artifacts, auditory function, and immunosuppressive drug effects, highlighting the need for targeted interventions.
Background:
With improvement in medical outcomes, the current research has shifted toward understanding and enhancing the quality of life after pediatric heart transplantation. Previous research has indicated that infant heart transplant recipients are generally at risk for neurodevelopmental delays; however, no longitudinal studies exploring the patterns of development within this medical population have been performed.
Methods:
Using the Bayley Scales of Infant Development-II, 39 children (2 to 38 months of age) who underwent heart transplantation in infancy (<1 year) at Loma Linda University Children's Hospital were assessed consecutively over time.
Results:
Mean Mental Development Index (MDI) scores for all age groups were within normal limits, except for the age ranges of 18 to 23 and 24 to 35 months, which were mildly delayed. Average Psychomoter Development Index (PDI) scores for all age groups reflected mildly delayed performance, except for the 36- to 38-month age group, which was within normal limits. Repeated measures analyses of variance on a sub-set of participants with at least 4 consecutive assessments revealed within-subject effects on MDI scores (F = 5.7, p < 0.01), but not on PDI scores (F = 1.6, p = 0.22). Significant decreases in MDI scores at 18 and 28 to 36 months were noted.
Conclusions:
Motor development in this population was consistently mildly delayed. Age-dependent variability in cognitive skills was apparent. The delays appeared due to speech/language acquisition (18 months), and abstract reasoning/goal-directed behaviors (28 to 36 months). Possible etiologies for cognitive delays include test artifacts, auditory functioning and effects of immunosuppressive agents. Understanding risk factors in this patient population will allow for early and effective intervention.
