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Neurodevelopmental outcomes in preschool children with congenital heart defects: A case-control study using Ages &
Simone Hansen1, Cathrine Vedel1, Jesper Steensberg2
1Center of Fetal Medicine, Department of Gynecology, Fertility, and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Children with surgically corrected congenital heart defects (CHD) showed similar overall neurodevelopmental scores to controls. However, they had increased odds of low scores, particularly those with prenatally undetected Ventricular Septal Defects (VSD).
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Congenital Heart Disease Research
Background:
- Congenital heart defects (CHD) requiring surgery can impact neurodevelopmental outcomes in children.
- Early identification and intervention are crucial for managing potential developmental delays in this population.
- Understanding neurodevelopmental trajectories post-surgery informs long-term care strategies.
Purpose of the Study:
- To compare neurodevelopmental outcomes in preschool children with surgically treated CHD versus healthy controls.
- To identify specific CHD subtypes or conditions associated with developmental risks.
- To inform clinical follow-up protocols for children with complex congenital heart conditions.
Main Methods:
- A cohort of Danish children born 2016-2018 undergoing first-year surgery for specific CHDs (VSD, AVSD, CoA, DORV, TOF, TGA) was studied.
- Exclusion criteria included prematurity, twins, and genetic aberrations; cases were matched with controls.
- Neurodevelopmental assessment at 33-60 months used the Ages & Stages Questionnaire (ASQ); statistical analysis involved Mann-Whitney U and logistic regression.
Main Results:
- Overall ASQ scores did not differ between 105 CHD cases and 179 controls (p=0.12).
- Cases exhibited a five-fold increased odds of low ASQ scores (OR 5.02) after adjusting for covariates.
- This increased risk was primarily linked to prenatally undetected Ventricular Septal Defects (VSD); Transposition of the Great Arteries (TGA) cases also showed lower scores, especially when undetected prenatally.
Conclusions:
- While overall neurodevelopmental scores are comparable, children with surgically corrected CHD have a significantly higher risk of developmental delays.
- Prenatal detection status is a critical factor, with undetected VSD and TGA posing greater risks.
- Routine neurodevelopmental follow-up is recommended for all surgically treated CHD patients to address potential delays.
Objectives:
To investigate neurodevelopmental outcome in preschool children with a CHD (congenital heart defect) requiring surgery compared to healthy controls.
Materials And Methods:
This study includes all Danish children born between 2016-2018 who underwent surgery within the first year for Ventricular Septal Defect (VSD), atrioventricular septal defect, coarctation of the aorta, double outlet right ventricle, tetralogy of fallot, and Transposition of the Great Arteries (TGA). Exclusion criteria: preterm birth (<37 weeks), twins, and genetic aberrations. Cases were matched with two to four healthy controls on age, sex, gestational age at delivery, and region of birth. Neurodevelopmental outcome at 33-60-months was assessed by the Ages & Stages Questionnaire (ASQ). Comparisons were performed by the Mann-Whitney U test and logistic regression analysis and presented as p-values and odds ratios (OR) with 95% confidence intervals (CI).
Results:
There were no differences in ASQ score between 105 cases with any CHD (230 (IQR 195-260)) and 179 controls (235 (IQR 205-265)), p = 0.12. Cases had five-fold increased odds of a low score compared to controls after adjusting for maternal educational level and children's age at ASQ completion (OR 5.02, 95% CI 1.49;16.90). This was primarily driven by cases with prenatally undetected VSD, where 20% scored below -2 standard deviations. No differences were found across individual CHD subgroups. In cases with prenatally undetected TGA, the total ASQ score was 185 (IQR 145-190) compared to 220 (IQR 190-270) in prenatally detected TGA, p = 0.08.
Conclusions:
The overall ASQ score in children with surgically corrected CHD was comparable to controls. However, cases had five-fold increased odds of a low score, primarily driven by children with prenatally undetected VSD. Additionally, ASQ scores were lower in TGA cases, especially when undetected prenatally, though not significant. These findings suggest follow-up of all children with a CHD requiring surgery including awareness of potential developmental delays.
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