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[Cognitive and motor abilities and behavioural outcome in children after neonatal operation with cardiopulmonary
N Vahsen1, M Kavsek, N Toussaint-Götz
1Deutsches Kinderherzzentrum Sankt Augustin, St. Augustin. n.vahsen@asklepios.com
Insights
Children undergoing arterial switch operation for d-transposition of the great arteries showed lower general intelligence and motor skills. Early neurodevelopmental assessment and interventions are crucial for these patients.
Area of Science:
- Pediatric Cardiology
- Developmental Neuroscience
- Surgical Outcomes
Background:
- Cognitive, motor, and psychic development in d-transposition of the great arteries (dTGA) patients post-arterial switch operation (ASO) requires clarification.
- Previous studies lack consensus due to variations in patient status, perinatal care, and surgical quality.
- This study isolates surgical quality by examining patients operated by a single surgeon.
Purpose of the Study:
- To evaluate the long-term neurodevelopmental outcomes in children following neonatal arterial switch operation for dTGA.
- To identify potential risk factors associated with developmental impairments after ASO.
- To inform the necessity of targeted interventions for affected children.
Main Methods:
- A cohort of 30 children, operated as neonates for dTGA, were assessed between 4.3 and 12.5 years of age.
- Neurodevelopmental assessment included the Kaufman-Assessment Battery for Children (K-ABC) for intelligence, Movement Assessment Battery for Children (M-ABC) for motor skills, and Child Behaviour Checklist (CBCL/4-18) for behavior.
- Data analysis focused on comparing patient outcomes to population norms and identifying risk factors.
Main Results:
- Patients demonstrated significantly lower general intelligence compared to population means, while acquired abilities were within normal limits.
- Gross and fine motor functions were below average.
- Parents reported a higher incidence of behavioral problems in patients compared to the general population.
- Surgical duration and postoperative complications were identified as risk factors for reduced general intelligence.
Conclusions:
- Neonatal arterial switch operation for dTGA is linked to deficits in general intelligence, motor function, and increased behavioral issues.
- There is a clear need for systematic neurodevelopmental assessment post-ASO to detect delays.
- Early intervention strategies are recommended to support optimal development in these children.
Background:
Empirical results about the cognitive, motor and psychic development in patients with d-transposition of the great arteries after arterial switch operation remain unclear. Potential reasons are the patients' initial status, improved perinatal care or the quality of surgery. To exclude quality of surgery as the main reason, only children, who were operated by the same surgeon, were included in this study.
Patients:
Thirty children operated as neonates were examined at the age of 4.3 to 12.5 years.
Method:
The Kaufman-Assessment Battery for Children (K-ABC) was administered to assess general intelligence and acquired abilities, the Movement Assessment Battery for Children (M-ABC) to assess gross and fine motor function and the Child Behaviour Checklist (CBCL/4-18) to assess behaviour problems.
Results:
General intelligence was significantly lower than the population means, whereas the acquired abilities were within the normal range. Motor function also was below average. Parents reported significantly more behaviour problems in patients compared to the normal population. Risk factors for lower general intelligence were the duration of the operation and postoperative complications.
Conclusions:
The arterial switch operation performed during the neonatal period is associated with lower general intelligence, motor impairment and behaviour problems. Careful assessment of neurodevelopmental outcome for the detection of developmental delays and early initiation of interventions seem to be necessary.
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