Later Competence and Adaptation in Infants Who Survive Severe Heart Defects

Abstract

A model of risk potential for developmental outcome was created based on cardiac, medical, surgical, and family-stress factors in 31 children with transposition of the great arteries who had undergone reparative open heart surgery utilizing cardiopulmonary bypass during infancy. Impact of these potential risk factors was assessed by 4 current neurologic measures (neurologic anatomic abnormalities, functional impairment, electroencephalograph [EEG], and Pattern Visual Evoked Potential [PVEP]) and 4 psychologic measures (IQ, achievement, perceptual-motor function, and behavior). Results indicated that adverse developmental outcome was significantly associated with the following medical risk variables: failure of palliative surgery to alleviate hypoxia, prolonged hypoxia, growth failure, congestive heart failure, absence of ameliorating shunting heart defects, stroke, and CNS infection; and two psychosocial moderator variables: socioeconomic status and current life stress. Analysis of a "cumulative risk score" indicated significantly higher risk scores in children with abnormal EEGs, PVEPs, and neurologic examinations. The cumulative risk score highly correlated with composite neurologic outcome (r = .62), IQ (r = -.66), achievement (r = -.60), and perceptual-motor function (r = -.48). While overall outcome was favorable for children with TGA who experienced a single risk event, outcome was compromised if multiple risk factors occurred.

Controlled study of preschool development after surgery for congenital heart disease

“…37 The impact on development of chronic illness in general, rather than specific diagnoses, is further supported by the failure to find differences preoperatively between children with cyanotic lesions and those with acyanotic lesions. Although this is contrary to previous findings,13 16 these have focused on older children rather than the preschool age children investigated in our study.…”

“…Although the cyanotic group did not show a loss of skills over time, they did not achieve the improved rate of development expected in one year. Poor developmental outcome after surgery in infancy has also been linked to a number of family variables, such as socioeconomic status 13. Maternal overprotection is also particularly relevant for the cyanotic group, with mothers of three of the six cyanotic patients in the younger age group specifically mentioning that their children were very dependent and clingy and that they did not mix with other children.…”

“…However, even after correction of cyanotic lesions, considerable neurodevelopmental and cognitive deficits may remain 2324 There is some evidence that postponing the repair of cyanotic lesions is associated with progressive impairment in cognitive functioning 1314 25In children with acyanotic lesions, in contrast, no relation has been found between age at surgery and cognitive impairment 13…”

Cognitive function and behavioural status in paediatric heart and heart-lung transplant recipients: the Harefield experience

“…The open heart surgery group was predominantly children with acyanotic lesions, whereas the transplant group consisted of a higher proportion of children with cyanotic heart disease, for whom cognitive performance might be expected to be impaired 9, 23. There were also children with an initial diagnosis of cardiomyopathy or cystic fibrosis, which are not known to have any deleterious effect on brain development.…”

“…Furthermore, most of them were of school age and were heart rather than heart-lung recipients. Cognitive impairment8, 9 and behavioural and emotional10, 11 disturbance have been reported in children who have had open heart surgery, particularly for cyanotic conditions. Adverse effects have also been reported in parents12 and siblings12, 13 of children with congenital heart disease.…”