Neurocognitive Functioning in Early School-age Children With Intestinal Failure
Anna Gold1,2,3, Ashley Danguecan1, Christina Belza2,3
1Department of Psychology.
Insights
Children with intestinal failure (IF) show increased neurocognitive risks by early school age. Managing early septic episodes may mitigate these long-term risks in children with IF.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Pediatrics
- Pediatric Rehabilitation
Background:
- Intestinal failure (IF) significantly impacts child development.
- Limited data exists on school-age neurocognitive outcomes for children with IF.
- Understanding these outcomes is crucial for early intervention and support.
Purpose of the Study:
- To examine neurocognitive functioning in school-aged children with IF.
- To identify medical and demographic factors associated with neurocognitive outcomes.
- To inform strategies for improving long-term development in this population.
Main Methods:
- Neurocognitive assessments (intelligence, academics, learning, memory, language, motor skills) were performed on 28 children with IF.
- Diagnoses of Learning Disability, Intellectual Disability, and ADHD were made using DSM-IV/V criteria.
- Medical and demographic variables were collected and analyzed for correlations with cognitive outcomes.
Main Results:
- Forty-six percent of children received a cognitive/learning diagnosis.
- Higher numbers of first-year septic episodes correlated with poorer performance on most cognitive measures.
- Factors like prolonged first-year admissions, necrotizing enterocolitis, and hyperbilirubinemia were associated with adverse outcomes; having a sibling predicted better outcomes in several areas.
Conclusions:
- Children with IF are at significant risk for neurocognitive challenges in early school years.
- Proactive management of septic episodes in the first year is a key strategy to reduce long-term neurocognitive risks.
- Early identification and intervention are vital for supporting neurodevelopment in children with IF.
Objectives:
Little is known about school-age functioning in children with intestinal failure (IF). This study examines neurocognitive outcomes of children with IF at ages 4 to 8 years treated at a single centre, along with relevant medical and demographic variables.
Methods:
Between 2012 and 2016, neurocognitive assessments were administered to 28 children receiving treatment in our IF rehabilitation program, and included measures of intelligence, academics, learning/memory, language, visual-motor integration, and fine-motor dexterity. DSM-IV/V criteria were used to diagnose Learning Disability, Intellectual Disability, and/or Attention Deficit/Hyperactivity Disorder.
Results:
Intellectual functioning ranged from extremely low to superior (Full Scale IQ range 53-123, mean = 89). Forty-six percentage received a cognitive/learning DSM diagnosis. Total number of first-year septic episodes correlated with poorer outcomes on the most cognitive measures. Adjusting for gestational age (61% were born <37 weeks), number of first-year septic episodes negatively predicted working memory, visual-motor integration, and visual memory scores. Additional factors correlating with poorer outcomes on ≥2 cognitive measures included length of first-year admissions, necrotizing enterocolitis diagnosis, and first-year sustained conjugated hyperbilirubinemia. Having ≥2 first-year septic episodes increased the likelihood of poorer outcome. Having a sibling was a significant positive predictor of working memory, processing speed, reading, and verbal learning skills.
Conclusions:
Our data provides preliminary evidence that children with IF are at risk of neurocognitive problems at early school age. Managing septic events during the first year is one strategy that may help reduce long-term neurocognitive risks in this population.
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