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Effect of congenital heart disease on 4-year neurodevelopment within multiple-gestation births
Amy H Schultz1, Richard F Ittenbach2, Marsha Gerdes3
1Division of Cardiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Wash.
Insights
Infants with congenital heart disease needing surgery show poorer growth and neurodevelopment. This study in multiple-births found lower weight, cognitive scores, and fine motor skills at age 4.
Area of Science:
- Pediatric Cardiology
- Developmental Neuroscience
- Neonatology
Background:
- Congenital heart disease (CHD) is a significant concern in infant health.
- Surgical interventions like cardiopulmonary bypass (CPB) are critical for CHD treatment.
- Long-term neurodevelopmental outcomes and growth following infant CHD surgery require further investigation.
Purpose of the Study:
- To evaluate the impact of CHD requiring infant CPB surgery on neurodevelopmental outcomes and growth at 4 years of age.
- To control for confounding factors such as gestational age, socioeconomic status, and parental intelligence using a within-family design.
Main Methods:
- A within-family comparison study involving 14 multiple-gestation births where one sibling had CHD requiring CPB surgery by 6 months of age.
- Comprehensive neurodevelopmental assessments were conducted between 4 and 5 years of age.
- Paired comparisons between siblings with and without heart defects were performed using nonparametric tests.
Main Results:
- Children with CHD weighed less than their siblings (median weight-for-age z score: -0.4 vs 0.1, P=.02).
- Cognitive abilities were lower in children with CHD (median full-scale IQ: 99 vs 109, P=.02).
- Fine motor skills were significantly impaired in children with CHD (median Fine Motor score: 94.5 vs 107.5, P<.01).
Conclusions:
- Infant CHD requiring CPB surgery is associated with reduced weight at 4 years of age.
- Significant deficits in cognitive abilities and fine motor skills are observed in children with a history of infant CHD surgery.
- These findings highlight the importance of neurodevelopmental monitoring in children with CHD.
Objectives:
We sought to assess the effect of congenital heart disease requiring infant surgery with cardiopulmonary bypass on neurodevelopmental outcomes and growth at 4 years of age, while matching for gestational age, socioeconomic status, maternal gestational conditions, home environment, and parental intelligence by studying multiple-gestation births.
Methods:
We performed within-family comparison of 14 multiple-gestation births in which 1 child had congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age. Between 4 and 5 years of age, a comprehensive neurodevelopmental assessment was performed. Paired comparisons were conducted between siblings with and without heart defects using a series of nonparametric tests.
Results:
On average, the children qualified as late preterm (mean gestational age 35.4 ± 2.6 weeks). At an average age of 4.8 ± 0.1 years, children with congenital heart disease weighed less than their siblings (median weight for age z score -0.4 vs 0.1, P = .02) and had worse performance for cognition (median full-scale IQ 99 vs 109, P = .02) and fine motor skills (median Wide Range Assessment of Visual Motor Ability, Fine Motor score 94.5 vs 107.5, P < .01).
Conclusions:
After controlling for socioeconomic status, home environment, parental intelligence, and gestational factors by using multiple-gestation births, congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age is associated with lower weight, cognitive abilities and fine motor skills at 4 years of age.
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