Cognitive and Executive Function in Congenital Heart Disease: A Meta-analysis

Abstract

CONTEXT Cognitive function and executive function (EF) impairments contribute to the long-term burden of congenital heart disease (CHD). However, the degree and profile of impairments are insufficiently described. OBJECTIVE To systematically review and meta-analyze the evidence on cognitive function and EF outcomes in school-aged children operated for CHD and identify the risk factors for an unfavorable outcome. DATA SOURCES Cochrane, Embase, Medline, and PsycINFO. STUDY SELECTION Original peer-reviewed studies reporting cognitive or EF outcome in 5- to 17-year old children with CHD after cardiopulmonary bypass surgery. DATA EXTRACTION Results of IQ and EF assessments were extracted, and estimates were transformed to means and SE. Standardized mean differences were calculated for comparison with healthy controls. RESULTS Among 74 studies (3645 children with CHD) reporting total IQ, the summary estimate was 96.03 (95% confidence interval: 94.91 to 97.14). Hypoplastic left heart syndrome and univentricular CHD cohorts performed significantly worse than atrial and ventricular septum defect cohorts (P = .0003; P = .027). An older age at assessment was associated with lower IQ scores in cohorts with transposition of the great arteries (P = .014). Among 13 studies (774 children with CHD) reporting EF compared with controls, the standardized mean difference was −0.56 (95% confidence interval: −0.65 to −0.46) with no predilection for a specific EF domain or age effect. LIMITATIONS Heterogeneity between studies was large. CONCLUSIONS Intellectual impairments in CHD are frequent, with severity and trajectory depending on the CHD subtype. EF performance is poorer in children with CHD without a specific EF profile. The heterogeneity in studied populations and applied assessments is large. A uniform testing guideline is urgently needed.

Intelligence outcome of pediatric intensive care unit survivors: a systematic meta-analysis and meta-regression

“…This finding may reflect the greater disease severity, greater intensity of PICU treatments, and/or greater intensity of surgical treatment(s) of children admitted after heart- or heart–lung transplantation. The results on the PICU subgroups in the current study are in line with earlier literature overviews [ 36 – 42 ] and extend these findings by the unique focus on children admitted to the PICU and by providing comprehensive meta-analytic quantification of intelligence impairment.…”

Perioperative Course and Socioeconomic Status Predict Long-Term Neurodevelopment Better Than Perioperative Conventional Neuroimaging in Children with Congenital Heart Disease

“…The latest studies on diffusion tensor imaging have shown extensive persisting white matter changes 28,59,60 to be associated with neurodevelopmental outcome up to 30 months of age. 59 We were unable to replicate the finding of a large meta-analysis 8 demonstrating that more severe CHD complexity was associated with poorer neurodevelopmental outcome. However, this is most likely due to the small sample size of our cohort and the relatively few patients with single ventricle physiology.…”

“…1 In recent decades, the survival rate has increased to 85% to 90% due to improved surgical and perioperative management. [2][3][4] However, CHD patients are at risk of delayed neurodevelopment affecting cognition, language, motor function, [5][6][7][8] and executive function 8,9 during childhood and into adolescence [5][6][7][8][9] and adulthood. 10 Evidence is increasing that brain immaturity, 11 smaller brain volumes, [12][13][14][15] and perioperative brain injury 12,[16][17][18] are related to altered neurobehavior during the neonatal period 14,15 and delayed neurodevelopment during early childhood.…”

Similarities and Differences in the Neurodevelopmental Outcome of Children with Congenital Heart Disease and Children Born Very Preterm at School Entry

“…In contrast to these findings, one study reported higher rehabilitation service use in adolescents with CHD than in adolescents born VPT. 18 The imbalance in the number of therapies between these 2 clinical groups, regardless of the direction of imbalance, is inconsistent with the comparable extent of neurodevelopmental deficits that both clinical groups face as evidenced by the current and numerous previous studies (eg, 5,6,[8][9][10][11]13 ). In the current study, the lower prevalence of motor therapies in children with CHD was particularly misaligned with the pronounced motor problems apparent in these children.…”