Executive Functioning in Kindergarten-Aged Children After Complex Cardiac Surgery in Early Infancy

Executive function (EF) challenges occur in older children after complex cardiac surgery and can affect multiple aspects of daily life.

This is a prospective inception-cohort study of children after complex cardiac surgery (2009-2019) in early infancy assessed at age 4.5 years using the Behavior Rating Inventory of Executive Function Preschool Version. Independent predictors of clinically significant EF difficulties (T scores ≥65) were determined using multiple logistic regressions, reported as odds ratios (OR) with 95% confidence intervals (CI).

EF outcomes were available for 318 of 581 (55%) eligible survivors; 20.4% showed clinically significant global EF difficulties. In model 1, independent predictors included birth year for the Inhibitory Self-Control Index, maternal years of education for the Emergent Metacognition Index and Global Executive Composite (GEC), and the number of medical specialists at age 4.5 years for GEC. In model 2, which excluded more distal variables, independent predictors for the Inhibitory Self-Control Index were birth year (OR: 1.16, 95% CI: 1.04, 1.31; P = 0.008) and life-saving support (OR: 2.59, 95% CI: 1.14, 5.74; P = 0.021); maternal education predicted the Emergent Metacognition Index (OR: 0.84, 95% CI: 0.74, 0.96; P = 0.011); and maternal education (OR: 0.82, 95% CI: 0.71, 0.93; P = 0.003) and life-saving support (OR: 2.41, 95% CI: 1.08, 5.18; P = 0.027) predicted GEC.

The findings highlighted the risk of emerging EF difficulties in young children, especially those needing life-saving support. A study is needed to better understand how home environmental factors influence EF outcomes. Given the broad developmental impact of EF, early intervention may offer widespread, cumulative benefits.