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Published on: July 31, 2017
Early identification of autism spectrum disorder in children with CHD attending a Cardiac Developmental Outcomes
Faridis Serrano1, Danielle Guffey2, Lara Shekerdemian1
1Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Insights
Children with congenital heart disease (CHD) have a significantly higher risk of autism spectrum disorder (ASD), with diagnosis often occurring earlier. Key risk factors include being male, delayed surgery, ECMO, and seizures.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Disorders
- Congenital Heart Disease Research
Background:
- Congenital heart disease (CHD) affects neurodevelopment.
- Early diagnosis and intervention are crucial for children with autism spectrum disorder (ASD).
Purpose of the Study:
- To determine ASD prevalence and diagnosis timing in CHD patients.
- To identify risk factors for ASD in this cohort.
- To inform neurodevelopmental follow-up strategies.
Main Methods:
- Retrospective observational study of 361 infants undergoing CHD surgery within the first 6 months of life.
- Data collection included diagnosis age, demographics, and medical history.
- Multivariate logistic regression analysis was used to identify risk factors.
Main Results:
- ASD prevalence was 9.1% in the CHD cohort, with a median diagnosis age of 34 months.
- Increased odds of ASD were associated with male sex, surgery at ≥30 days, post-operative extracorporeal membrane oxygenation (ECMO), and seizures.
- Infants with ASD were diagnosed at a significantly earlier age than the general population.
Conclusions:
- Children with CHD exhibit a substantially higher risk of ASD compared to the general population.
- Specific factors like male sex, delayed surgery, ECMO, and seizures are linked to increased ASD risk.
- Neurodevelopmental follow-up is essential for infants with CHD post-cardiac surgery.
Objective:
To determine the prevalence and timing of autism spectrum disorder diagnosis in a cohort of congenital heart disease (CHD) patients receiving neurodevelopmental follow-up and identify associated risk factors.
Method:
Retrospective single-centre observational study of 361 children undergoing surgery for CHD during the first 6 months of life. Data abstracted included age at autism spectrum disorder diagnosis, child and maternal demographics, and medical history.
Results:
Autism spectrum disorder was present in 9.1% of children with CHD, with a median age at diagnosis of 34 months and 87.9% male. Prematurity, history of post-operative extracorporeal membrane oxygenation, and seizures were higher among those with autism (p = 0.013, p = 0.023, p = 0.001, respectively). Infants with autism spectrum disorder were older at the time of surgery (54 days vs 13.5 days, p = 0.002), and infants with surgery at ≥ 30 days of age had an increased risk of autism spectrum disorder (OR 2.31; 95% CI =1.12, 4.77, p = 0.023). On multivariate logistic regression analysis, being male (OR 4.85, p = 0.005), surgery ≥ 30 days (OR 2.46, p = 0.025), extracorporeal membrane oxygenation (OR 4.91, p = 0.024), and seizures (OR 4.32, p = 0.003) remained associated with increased odds for autism spectrum disorder. Maternal age, race, ethnicity, and surgical complexity were not associated.
Conclusions:
Children with CHD in our cohort had more than three times the risk of autism spectrum disorder and were diagnosed at a much earlier age compared to the general population. Several factors (male, surgery at ≥ 30 days, post-operative extracorporeal membrane oxygenation, and seizures) were associated with increased odds of autism. These findings support the importance of offering neurodevelopmental follow-up after cardiac surgery in infancy.
