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Survival without neurodevelopmental impairments among children with congenital heart disease at school age
Rabia Liamlahi1,2, Céline Steiner3,4,5, Melanie Ehrler3,4
1Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland. Rabia.Liamlahi@kispi.uzh.ch.
Insights
Only a quarter of children with complex congenital heart disease (cCHD) are free from neurodevelopmental impairments (NDI) by age 10. Higher socioeconomic status and early motor skills are protective factors for NDI in children with cCHD.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Child Health Outcomes
Background:
- Children with complex congenital heart disease (cCHD) face significant risks for neurodevelopmental impairments (NDI).
- Early identification of NDI is crucial for timely intervention and improved long-term outcomes.
- Understanding factors influencing NDI in this population is essential for targeted support.
Purpose of the Study:
- To determine the proportion of school-aged children with cCHD who are free from NDI.
- To identify protective factors associated with the absence of NDI in children with cCHD.
- To explore the relationship between the number of impaired neurodevelopmental domains and the need for support services.
Main Methods:
- Longitudinal assessment of five neurodevelopmental domains in children with cCHD.
- Retrospective analysis of prospectively collected data.
- Definition of 'survival without impairments' based on standardized scores (within 1 SD or above 10th percentile).
- Regression analyses to identify protective factors and associations with support needs.
Main Results:
- Mean neurodevelopmental outcomes were generally within normal limits, with the exception of motor skills.
- At age 10, 77.9% of 113 children exhibited impairments in at least one neurodevelopmental domain; only 22.1% were impairment-free.
- Increased number of impaired domains correlated with higher requirements for educational support.
- Higher socioeconomic status and better motor scores at age 4 predicted better outcomes.
Conclusions:
- A significant majority of children with cCHD experience neurodevelopmental impairments by school age.
- Higher socioeconomic status and early motor development are key predictors of neurodevelopmental well-being.
- Ongoing monitoring and early interventions are vital for improving outcomes in children with cCHD.
Background:
Children with complex congenital heart disease (cCHD) are at risk for neurodevelopmental impairments (NDI). This study aims to examine the proportion of school-age children with cCHD who exhibit no NDI and to identify protective factors.
Methods:
Outcomes of five neurodevelopmental domains were assessed longitudinally in children with cCHD. For this retrospective analysis of prospectively collected data, survival without impairments was defined as scores within 1 SD or above 10th percentile, for each domain. Regression analyses were conducted to identify protective factors and to investigate associations between number of impaired domains and the need for therapies and educational support.
Results:
Mean outcomes were within the normal range except for motor skills (z = -1.5, SD = 1.6). At age 10, 77.9% of 113 children showed impairments in at least one domain; only 22.1% had none. Having impairments in more domains was associated with higher rates of educational support (p = 0.04). Higher socioeconomic status (SES) (p = 0.02) and motor (p = 0.004) scores at 4 years predicted better outcomes.
Conclusions:
Despite mostly normal average outcomes, only one quarter of children with cCHD remain free of NDI by age 10. Higher SES and early motor functions predict survival without impairments, highlighting the importance of ongoing monitoring and intervention.
Impact:
Only one quarter of children born with complex congenital heart disease remain free of neurodevelopmental impairments at school age. 42.5% of school-age children with complex CHD show neurodevelopmental impairments in multiple domains, highlighting the need for ongoing monitoring and intervention to improve outcome. Socioeconomic status and early motor outcomes predict later survival without neurodevelopmental impairments.
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