Early school‐age cognitive performance post–pediatric heart transplantation

Abstract

Background: As survival in pediatric heart transplantation (HTx) has improved due to medical advances, the analysis of long-term outcomes impacting quality of life such as cognition and development becomes increasingly important. Neuropsychological assessments provide a comprehensive understanding of individual needs, allowing for the development of tailored recommendations and interventions. Methods: Routine neuropsychological assessment was completed between 5 and 7 years of age in this cohort of pediatric HTx recipients at our center (Jan 2014-Oct 2018), including tests of general intellect (WPPSI-IV, WISC-V), academics (WIAT-II/ III), perceptual-motor abilities (Beery VMI-6), and memory (CMS). Relevant medical variables were collected. Results: Among 25 children, the median age at testing was 6.7 (IQR:5.8-7.4) years, with a median time since HTx of 5.2 (IQR:4.8-6.8) years. Medical diagnoses included congenital heart disease (CHD; 56%) and cardiomyopathy (44%). Cognitive functioning across the intellectual, academic, and perceptual-motor domains fell within the low-average range, while memory abilities fell within the average range. DSM-5 clinical diagnoses were provided for 14 (56%) children: Intellectual Disability-Mild (20%), Learning Disability (20%), Language Disorder (8%), and Attention-Deficit/ Hyperactivity Disorder (12%). The presence of neurological issues and/or CHD predicted poorer performance on various neuropsychological domains. Conclusions: Over 50% of this cohort of pediatric heart transplant recipients seen for routine post-HTx neuropsychological assessment received a clinical psychological diagnosis, notably higher than rates in the general population. This population requires monitoring to ensure that high risk children are identified and successfully supported in school and their community.

Cognitive outcome and its neural correlates after cardiorespiratory arrest in childhood

“…At the same time, patients were most impaired on the numerical operations subtest, with the group average significantly below the standard mean of 100, producing a large effect size. This parallels the findings of a recent study, showing that children who underwent heart transplant were impaired on the three WIAT subtests used here, with numerical operations producing the lowest group mean (Gold et al, 2020). While numerical operations are not often studied in developmental populations with history of HI, our study still replicates findings from some studies where difficulties with numerical operations were found (Isaacs et al, 2001;Taylor et al, 2011).…”

Neurocognitive deficits and sequelae following severe hand, foot, and mouth disease from 2009 to 2017, in JiangSu Province, China: a long-term follow-up study

“…At present, more and more studies use the WPPSI-IV for clinical intervention and neuropsychological evaluation. For example, patients with post-paediatric heart transplantation (Gold et al, 2020), premature children (Ahn et al, 2019), patients treated with propranolol for infantile haemangioma treatment (González-Llorente et al, 2017), patients with anaemia (Murtaza et al, 2019), and so on had their cognitive performance evaluated by the WPPSI-IV test. Few studies has been reported that evaluated cognitive performance of children with severe HFMD (Chang et al, 2004), those that did were also limited to EV-A71 infection.…”

Quality of life and psychosocial outcomes of adults who were pediatric solid organ transplant recipients: A systematic review

“…However, childhood represents a vulnerable developmental period. Research has identified a high prevalence of trauma within the pediatric transplant field, 47,48 as well as a high prevalence of neuropsychological issues among pediatric SOT patients when compared to population norms 49–51 . While such findings might point to considerable risk factors of transplantation on long‐term QoL, they might also be capturing deleterious impacts of the underlying disease, which may further justify the benefits of early transplantation.…”

“…Research has identified a high prevalence of trauma within the pediatric transplant field, 47,48 as well as a high prevalence of neuropsychological issues among pediatric SOT patients when compared to population norms. [49][50][51] While such findings might point to considerable risk factors of transplantation on long-term QoL, they might also be capturing deleterious impacts of the underlying disease, which may further justify the benefits of early transplantation. Moreover, it is important to note that the rate of organ re-transplantation in adult patients, who are often transplanted in childhood, is high, 52 which may partially explain findings of older age at assessment and longer time since transplant to be associated with poorer overall QoL.…”

“…58,59 Previous research underscores the need for peer-based, virtual interventions to provide informational, social, and emotional support 60 that have been effective in other pediatric and young adult chronic illness populations. [61][62][63] Furthermore, given the documented neuropsychological deficits among pediatric SOT recipients, [47][48][49] coupled with the role of education as a protective factor in long-term QoL outcomes, 13,37 transplant care programs that include neuropsychological assessments can serve to optimize the learning needs of SOT recipients, 64 improve academic success, and increase the likelihood of employment or engagement in post-secondary study, thereby improving QoL. Taken together, these findings underscore that, beyond transplant physical health status, clinicians and allied health professionals should consider broader aspects of QoL, including education, employment, and social and community engagement to adequately assess and optimize outcomes.…”