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Detecting neurodevelopmental trajectories in congenital heart diseases with a machine-learning approach
Elisa Cainelli1, Patrizia S Bisiacchi2,3, Paola Cogo4
1Department of General Psychology, University of Padova, Padua, Italy. elisa.cainelli@unipd.it.
Insights
Children with congenital heart disease (CHD) show significant differences in cognitive and psychopathological domains compared to controls. Many patients exhibit ADHD-like profiles, highlighting the need for early and ongoing clinical attention.
Area of Science:
- Neuroscience
- Pediatric Cardiology
- Developmental Psychology
Background:
- Congenital heart disease (CHD) affects brain development.
- Neuropsychological and psychopathological outcomes in CHD require further investigation.
- Early cardiac surgery in CHD patients necessitates understanding long-term developmental impacts.
Purpose of the Study:
- To characterize the neuropsychological and psychopathological profiles of children with CHD.
- To identify potential clinical subtypes within the CHD population.
- To explore associations between clinical parameters and neurodevelopmental outcomes in CHD.
Main Methods:
- Prospective observational study of 74 children (37 with CHD, 37 controls) undergoing cardiac surgery before age five.
- Comprehensive neuropsychological and psychopathological assessments conducted at least 18 months post-surgery.
- Machine learning used for clustering and variable classification of psychopathological profiles.
Main Results:
- Children with CHD demonstrated significant differences in intelligence, language, executive functions, and memory compared to controls.
- Two psychopathological profiles emerged: a small group with high psychopathology symptoms and a larger group with ADHD-like features.
- No significant associations were found between neuropsychological/psychopathological outcomes and the clinical parameters studied.
Conclusions:
- Children with CHD exhibit substantial interindividual variability in neuropsychological and psychological outcomes.
- ADHD-like profiles are common in CHD patients, often under-recognized by clinicians.
- A lifespan approach is crucial for optimizing developmental trajectories in CHD patients due to ongoing brain maturation.
Abstract:
We aimed to delineate the neuropsychological and psychopathological profiles of children with congenital heart disease (CHD) and look for associations with clinical parameters. We conducted a prospective observational study in children with CHD who underwent cardiac surgery within five years of age. At least 18 months after cardiac surgery, we performed an extensive neuropsychological (intelligence, language, attention, executive function, memory, social skills) and psychopathological assessment, implementing a machine-learning approach for clustering and influencing variable classification. We examined 74 children (37 with CHD and 37 age-matched controls). Group comparisons have shown differences in many domains: intelligence, language, executive skills, and memory. From CHD questionnaires, we identified two clinical subtypes of psychopathological profiles: a small subgroup with high symptoms of psychopathology and a wider subgroup of patients with ADHD-like profiles. No associations with the considered clinical parameters were found. CHD patients are prone to high interindividual variability in neuropsychological and psychological outcomes, depending on many factors that are difficult to control and study. Unfortunately, these dysfunctions are under-recognized by clinicians. Given that brain maturation continues through childhood, providing a significant window for recovery, there is a need for a lifespan approach to optimize the outcome trajectory for patients with CHD.
