Area deprivation index as a predictor of neurodevelopmental follow-up in children with CHD

Neurodevelopment deficits are common among survivors of CHD and affect their future health and quality of life. Patients who have undergone cardiopulmonary bypass in infancy should have early, dedicated neurodevelopmental evaluation. There are many barriers to implementing this guidance. Our study examines the patterns of neurodevelopmental follow-up and outcomes in CHD patients in a rural, underserved, and resource-limited region.

We conducted a single-centre chart review of CHD patients seen from 2012 to 2024 and analysed trends in neurodevelopment follow-up, including the number of scheduled appointments, attended appointments, and missed appointments. We looked at whether area deprivation index was associated with differences in neurodevelopmental referral, attendance, and missed appointments. Area deprivation index is a composite measure of neighbourhood disadvantage based on income, education, employment, and housing quality.

Out of 1,060 patients in total, neurodevelopment appointments were scheduled for 270 (25%) of patients. The incidence of neurodevelopment diagnoses was similar across area deprivation index quartiles. Patients across area deprivation index quartiles had similar rates of attending at least one appointment, but children in the third and fourth quartiles had more than twofold higher odds of missing visits compared with those in the least deprived quartile. There was no significant difference in the age at which children received a neurodevelopment diagnosis.

CHD patients from more socially disadvantaged neighbourhoods were more likely to miss neurodevelopmental appointments. Area deprivation index, which is routinely available in major health record systems, may help identify patients at higher risk of poor follow-up.