Cognitive function in toddlers with congenital heart disease: The impact of a stimulating home environment

Bonthrone, Alexandra F; Chew, Andrew; Kelly, Christopher; Almedom, Leeza; Simpson, John; Victor, Suresh; Edwards, A. David; Rutherford, Mary A.; Nosarti, Chiara; Counsell, Serena J.

doi:10.1111/infa.12376

Cited by 28 publications

(32 citation statements)

References 52 publications

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“…38–40 Socioeconomic factors may contribute to an adverse maternal–fetal environment through maternal comorbidities such as smoking or diabetes that alter placental physiology or social determinants of health (eg, access to care, home environment). 41–43 Regardless of mechanism, our data suggest that fetal brain volume may be a useful biomarker for future fetal neuroprotection trials addressing these different physiologic pathways.…”

Section: Discussionmentioning

confidence: 89%

Fetal Brain Volume Predicts Neurodevelopment in Congenital Heart Disease

et al. 2022

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Background: Neurodevelopmental impairment is common in children with congenital heart disease (CHD), yet postnatal variables explain only 30% of the variance in outcomes. To explore whether the antecedents for neurodevelopmental disabilities might begin in utero , we analyzed whether fetal brain volume predicted subsequent neurodevelopmental outcome in children with CHD. Methods: Fetuses with isolated CHD and sociodemographically comparable healthy control fetuses underwent fetal brain MRI and 2-year neurodevelopmental evaluation with the Bayley Scales of Infant and Toddler Development (Bayley-III) and the Adaptive Behavior Assessment System (ABAS-3). Hierarchical regression evaluated potential predictors of Bayley-III and ABAS-3 outcomes in the CHD group, including fetal total brain volume adjusted for gestational age and sex, sociodemographic characteristics, birth parameters, and medical history. Results: The CHD group (n=52) had lower Bayley-III cognitive, language, and motor scores than the control group (n=26), but fetal brain volumes were similar. Within the CHD group, larger fetal total brain volume correlated with higher Bayley-III cognitive, language, and motor scores, and ABAS-3 adaptive functioning scores (r=0.32-0.47; all P<0.05), but not in the control group. Fetal brain volume predicted 10 21% of the variance in neurodevelopmental outcome measures in univariate analyses. Multivariable models that also included social class and postnatal factors explained 18-45% of the variance in outcome, depending on developmental domain. Moreover, in final multivariable models, fetal brain volume was the most consistent predictor of neurodevelopmental outcome across domains. Conclusions: Small fetal brain volume is a strong independent predictor of 2-year neurodevelopmental outcomes and may be an important imaging biomarker of future neurodevelopmental risk in CHD. Future studies are needed to support this hypothesis. Our findings support inclusion of fetal brain volume in risk stratification models and as a possible outcome in fetal neuroprotective intervention studies.

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Section: Discussionmentioning

confidence: 89%

Fetal Brain Volume Predicts Neurodevelopment in Congenital Heart Disease

et al. 2022

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“…Promoting cognitive development in early childhood after preterm birth might be particularly important, given that cognitive delays could negatively affect social, emotional, and behavioral development ( 34 , 35 , 36 ). Cognitively stimulating parenting (indexing the extent of a child’s access to cognitively stimulating items and experiences at home) has been shown to promote school success in both term- and preterm-born children ( 37 ) and cognitive function in toddlers with congenital heart disease ( 38 ). However, it is not clear whether cognitively stimulating parenting also positively affects the mental health sequelae associated with preterm birth.…”

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confidence: 99%

Associations Between Neonatal Brain Structure, the Home Environment, and Childhood Outcomes Following Very Preterm Birth

Vanes

Hadaya

Kanel

et al. 2021

Biological Psychiatry Global Open Science

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Background Very preterm birth is associated with an increased risk of childhood psychopathology and cognitive deficits. However, the extent to which these developmental problems associated with preterm birth are amenable to environmental factors or determined by neurobiology at birth remains unclear. Methods We derived neonatal brain structural covariance networks using non-negative matrix factorization in 384 very preterm infants (median gestational age [range], 30.29 [23.57–32.86] weeks) who underwent magnetic resonance imaging at term-equivalent age (median postmenstrual age, 42.57 [37.86–44.86] weeks). Principal component analysis was performed on 32 behavioral and cognitive measures assessed at preschool age ( n = 206; median age, 4.65 [4.19–7.17] years) to identify components of childhood psychopathology and cognition. The Cognitively Stimulating Parenting Scale assessed the level of cognitively stimulating experiences available to the child at home. Results Cognitively stimulating parenting was associated with reduced expression of a component reflecting developmental psychopathology and executive dysfunction consistent with the preterm phenotype (inattention-hyperactivity, autism spectrum behaviors, and lower executive function scores). In contrast, a component reflecting better general cognitive abilities was associated with larger neonatal gray matter volume in regions centered on key nodes of the salience network, but not with cognitively stimulating parenting. Conclusions Our results suggest that while neonatal brain structure likely influences cognitive abilities in very preterm children, the severity of behavioral symptoms that are typically observed in these children is sensitive to a cognitively stimulating home environment. Very preterm children may derive meaningful mental health benefits from access to cognitively stimulating experiences during childhood.

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“…Among known non-biological factors such as maternal education and deprivation, a cognitively stimulating environment is known to be a modifiable factor with the capability to overcome other factors contributing to deficits in neurodevelopment [140][141][142][143]. Bonthrone et al retrospectively assessed the level of cognitive stimulation of children with CHD by their parents and found that higher parent cognitive stimulation scores were associated with higher 22 month language and cognitive abilities [144]. A research group at the Instituto de Cardiologia de Rio Grande do Sul is investigating the effects of parent-administered early stimulation programs for children with CHD in a randomized prospective clinical trial by using 3 and 6 month neurodevelopmental scores as their primary endpoints (https://clinicaltrials.gov/ct2/show/NCT04152330, accessed on 3 November 2021).…”

Section: Early Stimulationmentioning

confidence: 99%

“…Thus, particular attention must be given to neurodevelopmental care during the hospitalization and after discharge in children from disadvantaged families. Recent study reporting the relationship between a stimulating home environment and cognitive abilities in toddlers with CHD showed no relationship between outcome scores and SES, clinical factors, or brain injury severity at 22 months [ 144 ] However, the sample size is relatively small and future studies assessing the impact of home environment stimulation with larger samples are required.…”

Section: Socioeconomic Statusmentioning

confidence: 99%

The Current Status of Neuroprotection in Congenital Heart Disease

et al. 2021

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Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.

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Cognitive function in toddlers with congenital heart disease: The impact of a stimulating home environment

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 28 publications

References 52 publications

Fetal Brain Volume Predicts Neurodevelopment in Congenital Heart Disease

Fetal Brain Volume Predicts Neurodevelopment in Congenital Heart Disease

Associations Between Neonatal Brain Structure, the Home Environment, and Childhood Outcomes Following Very Preterm Birth

The Current Status of Neuroprotection in Congenital Heart Disease

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