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Early school-age cognitive performance post-pediatric heart transplantation
Anna Gold1,2, Bianca C Bondi1, Jenna Ashkanase3,4
1Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Pediatric heart transplant recipients often show low-average cognitive and academic skills, with over half receiving psychological diagnoses. Early identification and support are crucial for these children's long-term well-being.
Area of Science:
- Pediatric Cardiology
- Neuropsychology
- Developmental Pediatrics
Background:
- Improved survival in pediatric heart transplantation (HTx) necessitates focus on long-term quality of life, including cognitive and developmental outcomes.
- Neuropsychological assessments are vital for understanding individual needs and guiding interventions in pediatric HTx survivors.
Purpose of the Study:
- To evaluate the cognitive and developmental outcomes of pediatric heart transplant recipients.
- To identify the prevalence of psychological diagnoses in this population and factors predicting outcomes.
Main Methods:
- Conducted routine neuropsychological assessments in 25 pediatric HTx recipients aged 5-7 years.
- Included tests of general intellect, academics, perceptual-motor abilities, and memory.
- Collected relevant medical variables, including diagnoses and time since transplantation.
Main Results:
- Cognitive, academic, and perceptual-motor functioning were in the low-average range; memory was in the average range.
- 56% of children received a DSM-5 clinical diagnosis, including Mild Intellectual Disability and Learning Disability.
- Neurological issues and congenital heart disease predicted poorer neuropsychological performance.
Conclusions:
- Over 50% of pediatric HTx recipients in this cohort received a clinical psychological diagnosis, exceeding general population rates.
- This population requires ongoing monitoring for early identification and support in educational and community settings.
Background:
As survival in pediatric heart transplantation (HTx) has improved due to medical advances, the analysis of long-term outcomes impacting quality of life such as cognition and development becomes increasingly important. Neuropsychological assessments provide a comprehensive understanding of individual needs, allowing for the development of tailored recommendations and interventions.
Methods:
Routine neuropsychological assessment was completed between 5 and 7 years of age in this cohort of pediatric HTx recipients at our center (Jan 2014-Oct 2018), including tests of general intellect (WPPSI-IV, WISC-V), academics (WIAT-II/III), perceptual-motor abilities (Beery VMI), and memory (CMS). Relevant medical variables were collected.
Results:
Among 25 children, the median age at testing was 6.7 (IQR:5.8-7.4) years, with a median time since HTx of 5.2 (IQR:4.8-6.8) years. Medical diagnoses included congenital heart disease (CHD; 56%) and cardiomyopathy (44%). Cognitive functioning across the intellectual, academic, and perceptual-motor domains fell within the low-average range, while memory abilities fell within the average range. DSM-5 clinical diagnoses were provided for 14 (56%) children: Intellectual Disability-Mild (20%), Learning Disability (20%), Language Disorder (8%), and Attention-Deficit/Hyperactivity Disorder (12%). The presence of neurological issues and/or CHD predicted poorer performance on various neuropsychological domains.
Conclusions:
Over 50% of this cohort of pediatric heart transplant recipients seen for routine post-HTx neuropsychological assessment received a clinical psychological diagnosis, notably higher than rates in the general population. This population requires monitoring to ensure that high risk children are identified and successfully supported in school and their community.
