Effect of congenital heart disease on 4-year neurodevelopment within multiple-gestation births

Abstract

Objectives We sought to assess the effect of congenital heart disease requiring infant surgery with cardiopulmonary bypass on neurodevelopmental outcomes and growth at four years of age, while matching for gestational age, socioeconomic status, maternal gestational conditions, home environment, and parental intelligence by studying multiple gestation births. Methods We performed within-family comparison of 14 multiple gestation births in which one child had congenital heart disease requiring surgery with cardiopulmonary bypass at ≤ 6 months of age. Between four and five years of age, a comprehensive neurodevelopmental assessment was performed. Paired comparisons were conducted between siblings with and without heart defects using a series of non-parametric tests. Results On average, the children qualified as late preterm (mean gestational age 35.4 ± 2.6 weeks). At an average age of 4.8 ± 0.1 years, children with congenital heart disease weighed less than their siblings (median weight for age z-score −0.4 vs 0.1, p = 0.02) and had worse performance for cognition (median full scale IQ 99 vs. 109, p = 0.02) and fine motor skills (median Wide Range Assessment of Visual Motor Ability, Fine Motor score 94.5 vs. 107.5, p < 0.01). Conclusions After controlling for socioeconomic status, home environment, parental intelligence, and gestational factors by using multiple gestation births, congenital heart disease requiring surgery with cardiopulmonary bypass at ≤ 6 months of age is associated with lower weight, cognitive abilities and fine motor skills at 4 years of age.

Genetic contribution to neurodevelopmental outcomes in congenital heart disease: are some patients predetermined to have developmental delay?

“…Domains frequently affected include executive function, attention and self-regulation, visuospatial skills, and social cognition. [6–10] Psychiatric morbidity (e.g., anxiety) is also emerging as an important consideration. [11] These neurodevelopmental and behavioral challenges significantly impact academic achievement.…”

New versatile dual‐support pediatric heart pump

“…Pediatric patients with cardiomyopathy, the most common cause of heart failure in children, suffer from severely depressed ventricular function . These patients are susceptible to manifest developmental challenges, such as cognitive impairment, growth delays, heart arrhythmias, and CHF …”

“…Current therapeutic strategies include the administration of pharmacologic agents, which lead to symptomatic improvement, but do not halt progression to CHF . The shortage of donor organs and the added difficulty of donor/recipient size matching in pediatric patients complicate cardiac transplantation and extend donor waiting periods .…”

“…5 These patients are susceptible to manifest developmental challenges, such as cognitive impairment, growth delays, heart arrhythmias, and CHF. 6 Current therapeutic strategies include the administration of pharmacologic agents, which lead to sym ptomatic Abstract Mechanical circulatory support (MCS) devices for pediatric patients continue to lag in development behind those for adults. There is no heart pump with the design innovation to support dysfunctional states of heart failure and the anatomic heterogeneity of cardiac defects in pediatric patients.…”

“…blood pump, mechanical circulatory assistance, pediatric circulatory support, rotary blood pump, total artificial heart, ventricular assist device improvement, but do not halt progression to CHF. [5][6][7][8] The shortage of donor organs and the added difficulty of donor/ recipient size matching in pediatric patients complicate cardiac transplantation and extend donor waiting periods. 2,5 Due to these challenges, the implementation of mechanical circulatory support (MCS) devices in pediatric patients continues to rise.…”