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Impacts of an Interdisciplinary Developmental Follow-Up Program on Neurodevelopment in Congenital Heart Disease: The
Solène Fourdain1,2, Laura Caron-Desrochers1,2, Marie-Noëlle Simard1,3,4
1Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.
Insights
Early developmental follow-up for children with complex congenital heart disease (CHD) shows subtle neurodevelopmental benefits, particularly in receptive language skills. Further research is needed to confirm long-term effectiveness.
Area of Science:
- Pediatric Cardiology
- Developmental Neuroscience
- Child Health
Background:
- Complex congenital heart disease (CHD) and cardiac surgery can impact neurodevelopment.
- Early intervention programs aim to mitigate these neurodevelopmental risks.
- Systematic developmental follow-up is crucial for monitoring and supporting affected children.
Purpose of the Study:
- To investigate the impact of an early, systematic, interdisciplinary developmental follow-up and individualized intervention program.
- To assess neurodevelopmental outcomes in children with complex CHD who underwent cardiac surgery.
- To compare outcomes between children in a specialized neurocardiac clinic and those receiving standard care.
Main Methods:
- Prospective enrollment of 80 children with complex CHD.
- Comparison between 41 children in a neurocardiac developmental follow-up clinic and 39 receiving standard care.
- Cognitive, motor, and behavioral assessments at 3 years of age using multivariate analyses of variance.
Main Results:
- Children in the follow-up clinic showed better receptive language (P=0.048) and visuo-constructive task scores (P=0.080).
- Standard care group performed better in working memory tasks (P=0.032).
- No significant group differences in global intellectual functioning, motor skills, or behavior were observed. Referral rates for remedial services were higher in the follow-up group (P<0.005).
Conclusions:
- The developmental follow-up program had a subtle impact on neurodevelopmental outcomes.
- An advantage in receptive language skills was observed in the intervention group.
- Larger cohorts and school-age assessments are needed to fully determine the long-term effectiveness of neurocardiac developmental follow-up programs.
Abstract:
Objectives: This study investigates the impact of an early systematic interdisciplinary developmental follow-up and individualized intervention program on the neurodevelopment of children with complex congenital heart disease (CHD) who required cardiac surgery. Study Design: We prospectively enrolled 80 children with CHD: 41 were already followed at our neurocardiac developmental follow-up clinic from the age of 4 months, while 39 were born before the establishment of the program and therefore received standard health care. We conducted cognitive, motor, and behavioral assessments at 3 years of age. We used one-way multivariate analyses of variance to compare the neurodevelopmental outcome of both groups. Results: Between-group analyses revealed a distinct neurodevelopmental profile with clinically significant effect size (P < 0.001, partial η2 = 0.366). Children followed at our clinic demonstrated better receptive language performances (P = 0.048) and tended to show higher scores on visuo-constructive tasks (P = 0.080). Children who received standard health care exhibited greater performances in working memory tasks (P = 0.032). We found no group differences on global intellectual functioning, gross and fine motor skills, and behaviors. Referral rates for specific remedial services were higher in patients followed at our neurocardiac clinic compared to the historical cohort (P < 0.005). Conclusions: Overall, the impact of the developmental follow-up and individualized intervention program on neurodevelopmental outcomes remains subtle. Nevertheless, results, although limited by several factors, point toward an advantage for the children who took part in the program regarding receptive language skills over children who received standard health care. We hypothesize that group differences may be greater with growing age. Further research involving larger cohorts is needed to clearly assess the effectiveness of neurocardiac developmental follow-up programs at school age.
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