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Neurodevelopmental outcomes at 2 and 4 years in children with congenital heart disease
Cheryl L Brosig1,2, Laurel Bear1,2, Sydney Allen1
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Neurodevelopmental (ND) delays in children with congenital heart disease (CHD) may be underestimated by early testing. Longitudinal ND assessments are recommended as delays can emerge by age 4.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Developmental Psychology
Background:
- Children with congenital heart disease (CHD) face a higher risk of neurodevelopmental (ND) delays.
- Early identification and monitoring of these delays are crucial for timely intervention.
Purpose of the Study:
- To compare ND test results in children with CHD at 2 and 4 years of age.
- To determine if the prevalence of ND delays changes between these two age points.
Main Methods:
- Children with CHD underwent neurodevelopmental testing at 2 years (Bayley Scales of Infant Development-III) and 4 years (standardized neuropsychological measures).
- Scores were categorized as average, at risk, or delayed based on standard deviations from test norms.
- Statistical analyses, including Pearson correlations and McNemar's exact tests, were used to assess score relationships and changes over time.
Main Results:
- Sixty-four children completed assessments at both 2 and 4 years of age.
- Strong correlations were found between cognitive and fine motor scores at 2 and 4 years (r = .75 to .87, P < .0001).
- A higher proportion of children exhibited at-risk or delayed scores at age 4 compared to age 2 (P ≤ .01).
Conclusions:
- While 2-year test scores correlate with 4-year scores, early results may underestimate later-identified delays.
- A significant number of children scoring in the average range at age 2 showed deficits by age 4.
- Longitudinal ND assessment is recommended for children with CHD to accurately track developmental trajectories.
Background And Objectives:
Children with congenital heart disease (CHD) are at risk for neurodevelopmental (ND) delays. The purpose of this study is to compare the ND testing results of children with CHD at 2 and 4 years of age and determine if rates of ND delays change over time.
Methods:
Children with CHD completed the Bayley Scales of Infant Development-III (BSID-III) at 2 years of age, and standardized neuropsychological measures at 4 years. Scores were compared with test norms and were classified as: average (within one SD of test mean); at risk (1-2 SDs from the test mean); and delayed (>2 SD from test mean). Pearson correlations and McNemar's exact tests were performed to determine the relationship between test scores at the two times of assessment.
Results:
Sixty-four patients completed evaluations at 24 ± 3 months of age and 4 years of age. BSID-III cognitive and fine motor scores were correlated with preschool IQ and fine motor scores, r = .75 to .87, P < .0001. Agreement in score categories was 79% for cognitive and 61% for fine motor. More patients had at risk or delayed scores at age 4 vs age 2 (P ≤ .01).
Conclusion(S):
Despite significant correlations between 2- and 4-year-old test scores, many patients who scored in the average range at age 2 showed deficits at age 4. BSID-III scores at age 2 may underestimate delays. Therefore, longitudinal ND assessment is recommended.
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