Beyond the first year after pediatric heart or heart‐lung transplantation: Changes in cognitive function and behaviour

Abstract

With the increasing use and improved survival rates of heart and lung transplantation as treatments for children with end-stage heart or lung disease, attention is focusing on the longer term psychological implications of these procedures. This paper focuses on the changes in cognitive development and behaviour in a group of 47 children who were seen 12 months and 2 yr after transplantation. There were 24 boys and 23 girls, mean age at transplantation was 8.3 yr (s.d. 5.3 yr), with a range of 0.3-15.1 yr. Assessments were made of developmental level, cognitive ability and problem behaviours, using previously validated measures, and comparisons were made with physically healthy children. For children under three and a half years of age there was a decrease over time in scores on all developmental parameters, with the change reaching significance on the scale assessing eye-hand coordination and on the overall IQ. Whilst all scores were within the normal range, they were at a significantly lower level than those of the healthy children. In contrast, there were no changes over time on any measures of cognitive or academic ability for older children, with correlations between 12 month and 2 yr scores being highly significant. The rate of behaviour problems at home at 12 months was 22%, compared with 34% at 2 yr post-transplant, which was higher than that found in the healthy children. Conversely, there was a drop in the prevalence of behaviour problems at school from 23% at 12 months to 9% at 2 yr. It is concluded that a significant minority of children and adolescents experience psychological difficulties 2 yr after transplant, with particular areas of concern focusing on development in the younger children and the occurrence of behaviour problems at home across the age-range.

Developmental Outcomes After Pediatric Heart Transplantation

“…Children who received an allograft for congenital heart disease did not perform as well as those with cardiomyopathy. 21 In this report, spelling seemed to be more affected than reading or math skills. Younger recipients appeared to have greater difficulties with arithmetic skills.…”

“…One study noted that parents reported behavioral issues in 30% of the children at 12 months and 35% of the children at 2 years after transplantation. 21 The percentages for teacher reports of problem behavior, however, were 25% and 10% at the same time points. In this same study, problem behaviors at 12 months were positively correlated with problem behaviors at 2 years.…”

Neurocognitive function of pediatric heart transplant recipients

“…Evaluation methods developed for toddlers have been used frequently, yet these methods rely heavily on motor skills, and their predictive value is not great. 9,10 Specific neurocognitive deficits in school-aged children with HTx have emerged in the verbal domains of expressive and receptive language, 3,6,7 spelling, 1,2,4,11 and reading skills, 4,11 and also in visuomotor abilities, 3 nonverbal reasoning, 1 arithmetic, 3,4,11 short-term memory, 1 and speed of information processing. 1 A recent study 12 identified an increased risk for deficits in expressive language among infants and in visual-motor and fine-motor integration in children aged 1 to 10 years compared with test norms.…”

“…1,2 Older children have cognitive and academic performance in the low-average to average range. [3][4][5][6][7] As many as 15% to 46% of children undergoing HTx perform, in general, 2 standard deviations (SD) below test norms, indicating significant cognitive delays.…”

Cognitive and Psycholologic Considerations in Pediatric Heart Failure

“…In a companion study by the same group, psychologic difficulties in those who did not improve after transplantation persisted up to 2 years after transplantation and appeared to be more prevalent in younger patients. 24 Conversely, Menteer et al studied 62 pediatric patients with DCM and severe heart failure, and although they were found to have a significantly lower health-related quality of life (Peds QL) scores than comparable patients who recently underwent cardiac transplantation, there was no difference in the incidence of depression between the 2 groups or when compared with a group of 24 healthy control subjects. 21 Heart Failure in the Setting of Congenital Heart Lesions…”