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Neurocognition after paediatric heart surgery: a systematic review and meta-analysis
Caroline Sterken1, Jurgen Lemiere2, Ilse Vanhorebeek1
1Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine , KU Leuven , Leuven , Belgium.
Insights
Children with congenital heart disease (CHD) show poorer neurocognitive skills, including intelligence and alertness. These challenges can impact their daily functioning and academic performance, highlighting a need for targeted support.
Area of Science:
- Neuroscience
- Pediatrics
- Psychology
Background:
- Congenital heart disease (CHD) is linked to difficulties in academic and daily functioning.
- These challenges are associated with intelligence and neurocognitive skills, including executive functions (EFs), attention, and memory.
Purpose of the Study:
- To systematically review and meta-analyze neurocognitive data of children with CHD.
- To identify which neurocognitive functions are most consistently and prominently affected in children with CHD.
Main Methods:
- A systematic search of PubMed, EMBASE, and Cochrane databases was conducted for relevant studies.
- Data from 12 studies (647 CHD patients, 633 controls) and the Leuven glucose control trial were included in the meta-analysis.
- Standardized mean differences (SMDs) were calculated for intelligence, EFs, attention, and memory.
Main Results:
- Children with CHD performed worse than healthy controls across all assessed neurocognitive functions.
- A medium SMD was observed for intelligence (SMD=-0.53) and executive functions.
- Alertness was consistently poorer in the CHD group, while memory was less affected.
Conclusions:
- Children with CHD exhibit lower performance in intelligence and alertness, potentially contributing to daily life and academic difficulties.
- Heterogeneity in neurocognitive assessments and small study sizes may limit interpretation.
- Further research with standardized assessments is needed to fully understand neurocognitive deficits in CHD.
Unlabelled:
Children with congenital heart disease (CHD) often experience difficulties in academic and daily functioning, which have been associated with intelligence and neurocognitive skills, including executive functions (EFs), attention and memory. We report the neurocognitive data of children with CHD who were included in the Leuven glucose control trial (LGC trial). Through a systematic review and meta-analysis, we aimed to find which neurocognitive functions are most consistently and prominently affected. 365 children with CHD and 216 healthy control children underwent extensive neurocognitive testing in the LGC trial. A comprehensive search of electronic databases PubMed, EMBASE and Cochrane was conducted for studies measuring intelligence, EFs, attention and memory in children who underwent heart surgery for CHD. Standardised mean differences (SMDs) between the CHD group and a healthy control group were calculated for these neurocognitive functions. LGC trial data were included in the meta-analysis. Twelve studies with a healthy control group were included in the meta-analysis, involving 647 patients with CHD and 633 controls. The CHD group (median age 7.35 years at testing) had worse scores than healthy control children, for all investigated neurocognitive functions. A medium SMD was found for intelligence (SMD=-0.53 (95% CI -0.68 to -0.38), p<0.00001). Alertness, an attentional function, was also consistently poorer in the CHD group. Memory was less affected, while EF had a medium SMD with large heterogeneity. Children with CHD risk displayed lower performance on intelligence and alertness assessment, which may contribute to difficulties in daily life and school. Heterogeneity in neurocognitive assessment and small sizes in most studies limit the interpretation.
Trial Registration Number:
clinicaltrials.gov Identifier NCT00214916.
