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Published on: March 10, 2020
Risk and prevalence of developmental delay in young children with congenital heart disease
Kathleen A Mussatto1, Raymond G Hoffmann, George M Hoffman
1Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and.
Insights
Developmental delays are common in children with congenital heart disease (CHD). Longitudinal monitoring is crucial as these delays can change over time, impacting cognitive, language, and motor skills.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Neurodevelopmental Disorders
Background:
- Children with congenital heart disease (CHD) face a heightened risk of developmental delay (DD).
- Early childhood changes in cognitive, language, and motor skills in this population are not well-described.
- This study employs a structured, longitudinal approach to identify developmental issues and facilitate early intervention.
Purpose of the Study:
- To describe the trajectory of cognitive, language, and motor skills in infants and young children with CHD.
- To identify risk factors and patterns of developmental delay in this cohort.
- To inform early intervention strategies based on longitudinal data.
Main Methods:
- Bayley Scales of Infant Development, Third Edition, were administered to 99 children with CHD.
- Subjects underwent 3 to 6 evaluations within the first three years of life.
- Developmental delay was defined as a score more than 1 standard deviation below the population mean.
Main Results:
- 75% of subjects exhibited developmental delay in at least one area at one or more assessments.
- Children with single ventricle (1V) anatomy showed similar outcomes to those with two ventricle (2V) anatomy.
- Cognitive and language scores declined in children with genetic syndromes, while motor scores improved but remained low.
- Need for tube feeding, longer cardiopulmonary bypass time, and recent hospitalization predicted developmental outcomes.
Conclusions:
- Developmental delays are prevalent and dynamic in young children with CHD.
- Longitudinal surveillance is essential for children with CHD to track changing risks and developmental trajectories.
- Early and ongoing assessment can guide timely interventions for children with CHD.
Background And Objective:
Children with congenital heart disease (CHD) are at risk for developmental delay (DD). Changes in cognitive, language, and motor skills in early childhood have not been described. We report the results of a structured approach using longitudinal testing to identify problems and ensure early intervention in accordance with published guidelines.
Methods:
Bayley Scales of Infant Development, Third Edition, were used to assess cognitive, language, and motor skills in 99 children with CHD. Subjects were evaluated 3 to 6 times in the first 3 years of life. DD was defined as scores >1 SD below the population mean.
Results:
Cardiac anatomy was single ventricle (1V) in 34 subjects and 2 ventricles (2V) in 65. Medical comorbidities were present in 21% and genetic syndromes in 19%. Most subjects (75%) had DD in ≥1 area at ≥1 assessments. Subjects with 1V anatomy had equivalent outcomes to those with 2V. Cognitive and language scores declined in subjects with genetic syndromes but were stable and within the average range for subjects with 1V and 2V. Motor scores improved for subjects with 1V and 2V but remained low for those with genetic syndromes. In addition to age, need for supplemental tube feeding, longer cardiopulmonary bypass time, and shorter time since last hospitalization were significant predictors of developmental outcomes.
Conclusions:
DDs in young children with CHD are both common and dynamic. Providers should encourage longitudinal surveillance for children with CHD because exposure to risk and prevalence of DD change over time.
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