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Updated: Mar 15, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental functioning in children being evaluated for heart transplant prior to 2 years of age
Tanya N Antonini1, William J Dreyer2, Susan E Caudle1
1a Section of Psychology, Department of Pediatrics , Texas Children's Hospital/Baylor College of Medicine , Houston , TX , USA.
Insights
Children evaluated for heart transplant show significant neurodevelopmental delays in cognitive, language, and motor skills. Early intervention and ongoing monitoring are crucial for these high-risk pediatric patients.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Developmental Psychology
Background:
- Congenital heart defects are the most common birth defects.
- Children with severe heart disease, especially those awaiting heart transplant, face risks for developmental and neuropsychological delays.
- Early identification of neurodevelopmental challenges is critical for this vulnerable population.
Purpose of the Study:
- To investigate neurocognitive and adaptive functioning in young children (under 2 years) evaluated for heart transplant.
- To compare the performance of these children to normative samples.
- To identify specific domains of neurodevelopmental delay.
Main Methods:
- A cohort of 20 children under 2 years of age undergoing evaluation for heart transplant was assessed.
- Neurocognitive skills, including general cognition, language (receptive and expressive), fine motor, and gross motor skills, were evaluated.
- Adaptive functioning and social-emotional development were also assessed using standardized measures.
Main Results:
- Children demonstrated significant delays across multiple neurocognitive domains: general cognitive, receptive language, expressive language, fine motor, and gross motor skills.
- Adaptive and social-emotional functioning were significantly below normative levels.
- No significant differences in test performance were observed between patients with congenital heart defects and those with cardiomyopathy.
Conclusions:
- Young children evaluated for heart transplant exhibit widespread neurodevelopmental deficits.
- Intensive early intervention, including speech, occupational, and physical therapy, is recommended.
- Longitudinal monitoring of neurodevelopmental and neuropsychological functioning is essential for this patient group.
Abstract:
Cardiac defects represent the most common type of birth defect and children with these abnormalities are known to experience a variety of developmental and neuropsychological delays. Children receiving heart transplants may be at the highest risk for delays as they tend to represent the most severely ill patients with heart disease. This study investigates neurocognitive and adaptive functioning in 20 children under 2 years of age who were undergoing evaluation for heart transplant, comparing their performance to that of normative samples. The results indicate delays across various domains of neurocognition, including general cognitive, receptive language, expressive language, fine motor, and gross motor skills. In addition, adaptive and social-emotional functioning fell significantly below that of normative samples. No significant differences were found when comparing the test performance of patients with congenital heart defects (n = 12) to patients with cardiomyopathy (n = 8). Secondary analyses investigating the impact of genetic conditions, premature birth, and non-English language dominance showed minor changes in results across some domains, although this may have been due, at least in part, to decreased power to detect differences. Overall, this study's results support the need for early evaluation, intensive intervention (e.g., speech, occupational, and physical therapy), and continued monitoring of these patients' neurodevelopmental/neuropsychological functioning over time. Future research should examine longitudinal changes in development using both pre- and post-transplant data and should investigate the impact of early intervention.
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