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Developmental and functional outcomes at school entry in children with congenital heart defects
Annette Majnemer1, Catherine Limperopoulos, Michael Shevell
1School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada. annette.majnemer@mcgill.ca
Insights
Children with congenital heart defects (CHDs) who had open-heart surgery in infancy may face developmental and functional challenges at school entry, impacting learning and social participation.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Neurodevelopmental Outcomes
Background:
- Congenital heart defects (CHDs) are common birth defects.
- Surgical repair in infancy is standard for many CHDs.
- Long-term neurodevelopmental outcomes after infant cardiac surgery require ongoing investigation.
Purpose of the Study:
- To assess developmental and functional outcomes in children with CHDs at school entry.
- To identify factors associated with developmental and functional limitations post-infant open-heart surgery.
Main Methods:
- Prospective evaluation of 94 infants with CHDs who underwent surgical repair.
- Standardized developmental and functional assessments at approximately 5 years of age.
- Blind assessment of cognitive, language, behavioral, and adaptive functioning.
Main Results:
- Mean IQ scores were in the low average range; receptive language was average.
- Behavioral difficulties (27.1%) and functional limitations (11-17%) were common.
- Predictors included abnormal neurological exams, microcephaly, circulatory arrest time, and palliation.
Conclusions:
- Children undergoing infant open-heart surgery for CHDs may experience developmental difficulties.
- These difficulties can increase risks for learning challenges and reduced social participation.
- Early identification and intervention are crucial for optimizing outcomes.
Objective:
To describe developmental and functional outcomes of children with congenital heart defects (CHDs) at school entry after open heart surgery.
Study Design:
Infants with CHDs who underwent surgical repair in infancy were recruited and assessed prospectively for developmental progress. At 5 years of age (64.2 +/- 11.3 months), 94 subjects were evaluated in a blind fashion by using a variety of standardized measures.
Results:
Mean IQ scores were in the low average range (90-94). Receptive language was in the average range (103.6 +/- 14.4). Behavioral difficulties were common (27.1%), with internalizing problems being more frequent. Functional limitations in socialization (93.0 +/- 17.1), daily living skills (94.6 +/- 16.4), communication (90.0 +/- 14.1), and adaptive behavior (92.1 +/- 15.8) were noted in 11% to 17% of children. With the Functional Independence Measure for Children, 20% to 22% of subjects were more dependent than their peers in self-care and social cognition, although few (4.5%) had mobility restrictions. Predictors of developmental and functional limitations included: abnormal postoperative neurologic examination, microcephaly, deep hypothermic circulatory arrest time, palliation, acyanotic heart lesion, age at surgery, and maternal education.
Conclusions:
After infant open-heart surgery, children with CHDs may exhibit a range of developmental difficulties at school entry that enhances risk for learning challenges and decreased social participation.
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