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Long-term neurodevelopment in children with resected congenital lung abnormalities
Louis W J Dossche1, Casper M Kersten2, Tabitha Zanen-van den Adel3
1Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands. j.schnater@erasmusmc.nl.
Insights
Children with congenital lung abnormalities (CLA) generally show normal neurodevelopment. Some specific attention and motor function impairments were noted at age 8, but overall outcomes remain positive.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Pediatrics
- Congenital Abnormalities
Background:
- Congenital lung abnormalities (CLA) often require surgical resection.
- Long-term outcomes for CLA patients are generally favorable regarding lung function and surgery-related morbidity.
- Neurodevelopmental outcomes in children treated for CLA require further investigation.
Purpose of the Study:
- To assess neurocognitive and motor development in children who underwent resection of symptomatic congenital lung abnormalities (CLA).
- To compare the neurodevelopmental outcomes of these children with the general population.
- To identify potential risks for neurodevelopmental impairments following CLA surgery.
Main Methods:
- A prospective longitudinal study monitored neurocognitive and motor function in children (born 1999-2018) post-CLA resection.
- Assessments were conducted at 30 months, 5, 8, and 12 years of age.
- Statistical comparisons were made against Dutch population norms using one-sample t-tests and binomial proportion tests.
Main Results:
- At 8 years, significant impairments were observed in sustained attention and visuospatial memory in some children.
- While global neurocognitive outcomes were largely unimpaired, 18% of 8-year-olds exhibited definite motor problems, exceeding the expected rate.
- Overall, neurodevelopmental and motor function outcomes were found to be generally normal throughout childhood.
Conclusions:
- Surgical management of CLA is associated with generally normal neurodevelopmental outcomes.
- Specific areas like sustained attention, visuospatial memory, and motor function may show impairments in some individuals.
- Neurodevelopmental assessment is recommended for children post-CLA surgery primarily if associated morbidities exist or if functional concerns are raised by caregivers.
Abstract:
To determine whether children who underwent resection of a congenital lung abnormality (CLA) are at higher risk for neurodevelopmental impairments than peers in the general population. The study population consisted of children born between 1999-2018 who underwent resection of a symptomatic CLA. Neurocognitive development (intelligence, memory, attention, visuospatial processing, executive functioning) and motor function of this population are monitored through our structured, prospective longitudinal follow-up program at the ages of 30 months, 5, 8, and 12 years. We compared study population scores with Dutch norm values using one-sample t-tests and one-sample binominal proportion tests. Forty-seven children were analyzed. The 8-year-olds showed significant impairments in sustained attention through the Dot Cancellation Test (mean z-scores -2.4; [-4.1; -0.8], p = 0.006 and -7.1; [-12.8; -1.4], p = 0.02 for execution speed and fluctuations respectively). Visuospatial memory was impaired at 8 years, though only in 1 out of 3 assessment tools (Rey Complex Figure Test z-scores (-1.0; [-1.5; -0.5], p < 0.001). Further neurocognitive outcomes were unimpaired at all tested ages. Regarding motor function outcomes, mean z-scores of total motor functioning were unimpaired across assessed ages. However, at 8 years, significantly more children than expected had definite motor problems (18% vs 5%, 95% CI [0.052; 0.403], p = 0.022). Conclusion: This evaluation reveals impairment in some subtests of sustained attention, visuospatial memory and motor development. However, globally, normal neurodevelopmental outcomes were found throughout childhood. We recommend testing for neurodevelopmental impairments in children who underwent surgery for CLA only if associated morbidities are present or if caregivers express doubts about their daily functioning. What is Known: • In general, surgically managed CLA cases seldom suffer from long-term surgery-related morbidity and show favorable lung function. What is New: • Long-term neurocognitive and motor function outcome appear unimpaired within surgically managed CLA cases. We recommend testing for neurodevelopmental impairments in children who underwent surgery for CLA only if associated morbidities are present or if caregivers express doubts about their daily functioning.
