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Neurocognitive Development After Pediatric Heart Surgery
Caroline Sterken1, Jurgen Lemiere2, Greet Van den Berghe3
1Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, and caroline.sterken@med.kuleuven.be.
Insights
Children with congenital heart disease (CHD) do not show worsening neurocognitive deficits between ages 4 and 7. While intelligence and psychosocial deficits persist, children with CHD appear to partially overcome some challenges.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Disorders
- Child Psychology
Background:
- Children with congenital heart disease (CHD) often experience neurocognitive deficits impacting daily and academic functioning.
- These deficits may progressively worsen throughout childhood.
- Infant heart surgery in CHD patients may influence long-term neurocognitive outcomes.
Purpose of the Study:
- To investigate if children with CHD, who had infant heart surgery, exhibit increasing neurocognitive deficits, particularly in executive functions, as they age.
- To compare the neurocognitive development trajectory of children with CHD to that of healthy controls.
Main Methods:
- A longitudinal follow-up study involving 107 children with CHD and 77 healthy controls.
- Neurocognitive testing at age 4, with a follow-up assessment at age 7 for 93% of participants.
- Assessment of intelligence, visual-motor integration (VMI), alertness, motor coordination, executive functions, and psychosocial functioning.
Main Results:
- Children with CHD consistently showed lower IQ scores than controls.
- The IQ gap narrowed from 11.7 points at the first follow-up to 7 points at the second.
- Deficits in VMI, alertness, motor coordination, and psychosocial functioning did not worsen in the CHD group compared to controls between ages 4 and 7.
Conclusions:
- Children with CHD who underwent infant heart surgery do not exhibit an increase in neurocognitive deficits between ages 4 and 7.
- While deficits in intelligence, VMI, and psychosocial functioning persist, there is evidence of partial recovery or 'growing out' of some challenges.
Objectives:
Children with congenital heart disease (CHD) often have neurocognitive deficits, sometimes with a detrimental impact on daily and school functioning. These deficits may increase through childhood. In this study, we investigated whether children with CHD, who underwent heart surgery as infants, show more neurocognitive deficits, especially in the executive functions, as they get older, compared with healthy controls.
Methods:
In this longitudinal follow-up study, 107 children with CHD and 77 healthy control children underwent extensive neurocognitive testing at 4 years of age. Ninety-three percent of the children (100 patients with CHDs and 72 controls) underwent a second neurocognitive testing 3 years later. Intelligence, visual-motor integration (VMI), alertness, motor coordination, executive functions, and psychosocial functioning were assessed.
Results:
IQ scores were consistently lower in the CHD group (P < .001); however, the difference of 11.7 IQ points between both groups at follow-up 1 decreased to 7 IQ points at follow-up 2 (P = .003). Inhibition reaction time had improved in both study groups at follow-up 2 (P < .001) and did not differ between both groups from follow-up 1 to follow-up 2 (P = .849). Deficits in VMI, alertness, motor coordination, and psychosocial functioning also did not worsen for patients with CHDs at follow-up 2, compared with healthy controls.
Conclusions:
Children with CHD, who underwent heart surgery as infants, do not show an increase of neurocognitive deficits between the ages of 4 and 7 years, compared with healthy controls. Patients with CHDs keep deficits in intelligence, VMI, and psychosocial functioning, but seem to partially grow out of their deficits.
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