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Published on: March 10, 2020
Factors associated with neurodevelopment for children with single ventricle lesions
Caren S Goldberg1, Minmin Lu2, Lynn A Sleeper2
1University of Michigan Medical School and CS Mott Children's Hospital, Ann Arbor, MI.
Insights
Children with single right-ventricle anomalies show impaired neurodevelopment at age 3. Medical issues and early development scores impact outcomes, but shunt type does not. Longitudinal follow-up is crucial for recognizing delays in these children.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Congenital Heart Disease Research
Background:
- Single right-ventricle anomalies represent complex congenital heart defects requiring significant medical intervention.
- Early neurodevelopmental outcomes in affected children are a growing concern for long-term health.
- Understanding factors influencing neurodevelopment is critical for improving patient care.
Purpose of the Study:
- To evaluate neurodevelopment at 3 years in children with single right-ventricle anomalies.
- To examine associations between neurodevelopment, shunt type, early development, and medical factors.
- To identify predictors of neurodevelopmental outcomes in this population.
Main Methods:
- The study included survivors of the Single Ventricle Reconstruction Trial without cardiac transplant.
- Neurodevelopment was assessed at 3 years using the Ages and Stages Questionnaire (ASQ).
- Bayley Scales of Infant Development (BSID-II) scores from 14 months and medical history were analyzed as predictors.
Main Results:
- Children demonstrated significantly lower ASQ scores compared to normative data.
- Medical complications, growth abnormalities, and sensory/feeding issues correlated with poorer ASQ scores.
- No association was found between shunt type and neurodevelopmental or quality-of-life outcomes.
Conclusions:
- Children with single right-ventricle anomalies exhibit impaired neurodevelopment at 3 years of age.
- Medical morbidity and early neurodevelopmental scores (BSID-II) are associated with later outcomes, but shunt type is not.
- Current predictive models explain limited variation, underscoring the need for ongoing monitoring of all affected children.
Objective:
To measure neurodevelopment at 3 years of age in children with single right-ventricle anomalies and to assess its relationship to Norwood shunt type, neurodevelopment at 14 months of age, and patient and medical factors.
Study Design:
All subjects in the Single Ventricle Reconstruction Trial who were alive without cardiac transplant were eligible for inclusion. The Ages and Stages Questionnaire (ASQ, n = 203) and other measures of behavior and quality of life were completed at age 3 years. Medical history, including measures of growth, feeding, and complications, was assessed through annual review of the records and phone interviews. The Bayley Scales of Infant Development, Second Edition (BSID-II) scores from age 14 months were also evaluated as predictors.
Results:
Scores on each ASQ domain were significantly lower than normal (P < .001). ASQ domain scores at 3 years of age varied nonlinearly with 14-month BSID-II. More complications, abnormal growth, and evidence of feeding, vision, or hearing problems were independently associated with lower ASQ scores, although models explained <30% of variation. Type of shunt was not associated with any ASQ domain score or with behavior or quality-of-life measures.
Conclusion:
Children with single right-ventricle anomalies have impaired neurodevelopment at 3 years of age. Lower ASQ scores are associated with medical morbidity, and lower BSID-II scores but not with shunt type. Because only a modest percentage of variation in 3-year neurodevelopmental outcome could be predicted from early measures, however, all children with single right-ventricle anomalies should be followed longitudinally to improve recognition of delays.
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