Long-term Associations of an Early Corrected Ventricular Septal Defect and Stress Systems of Child and Mother at Primary School Age

Stonawski, Valeska; Vollmer, Laura L.; Köhler-Jonas, Nicola; Rohleder, Nicolas; Golub, Yulia; Purbojo, Ariawan; Moll, Gunther H.; Heinrich, Hartmut; Cesnjevar, Robert; Kratz, Oliver; Eichler, Anna

doi:10.3389/fped.2017.00293

Cited by 6 publications

(8 citation statements)

References 40 publications

(66 reference statements)

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“…Although we have previously shown that 1 week after ICU discharge of prolonged critically ill adult patients ACTH and cortisol levels had risen to supranormal levels [ 14 ], the current data suggest that the adrenal axis recovers thereafter. This finding is consistent with normal salivary cortisol levels observed in former critically ill children, assessed months to years after pediatric-ICU admission [ 21 , 22 ]. Interestingly, however, in acute-respiratory-distress-syndrome survivors, an inverse correlation has been reported between long-term basal serum cortisol level and increasing traumatic ICU memories [ 33 ].…”

Section: Discussionsupporting

confidence: 88%

“…Heterogeneous prolonged critically ill adult patients showed a uniform rise in ACTH and cortisol to supra-normal levels from ICU discharge to one week later [ 14 ]. In children, salivary cortisol levels were normal months to years after ICU admission [ 21 , 22 ]. In the absence of other data, it remained unclear whether the neuroendocrine abnormalities that are present in general adult ICU patients recover in the long-term.…”

Section: Introductionmentioning

confidence: 99%

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Persisting neuroendocrine abnormalities and their association with physical impairment 5 years after critical illness

et al. 2021

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Background Critical illness is hallmarked by neuroendocrine alterations throughout ICU stay. We investigated whether the neuroendocrine axes recover after ICU discharge and whether any residual abnormalities associate with physical functional impairments assessed 5 years after critical illness. Methods In this preplanned secondary analysis of the EPaNIC randomized controlled trial, we compared serum concentrations of hormones and binding proteins of the thyroid axis, the somatotropic axis and the adrenal axis in 436 adult patients who participated in the prospective 5-year clinical follow-up and who provided a blood sample with those in 50 demographically matched controls. We investigated independent associations between any long-term hormonal abnormalities and physical functional impairments (handgrip strength, 6-min walk distance, and physical health-related quality-of-life) with use of multivariable linear regression analyses. Results At 5-year follow-up, patients and controls had comparable serum concentrations of thyroid-stimulating hormone, thyroxine (T4), triiodothyronine (T3) and thyroxine-binding globulin, whereas patients had higher reverse T3 (rT3, p = 0.0002) and lower T3/rT3 (p = 0.0012) than controls. Patients had comparable concentrations of growth hormone, insulin-like growth factor-I (IGF-I) and IGF-binding protein 1 (IGFBP1), but higher IGFBP3 (p = 0.030) than controls. Total and free cortisol, cortisol-binding globulin and albumin concentrations were comparable for patients and controls. A lower T3/rT3 was independently associated with lower handgrip strength and shorter 6-min walk distance (p ≤ 0.036), and a higher IGFBP3 was independently associated with higher handgrip strength (p = 0.031). Conclusions Five years after ICU admission, most hormones and binding proteins of the thyroid, somatotropic and adrenal axes had recovered. The residual long-term abnormality within the thyroid axis was identified as risk factor for long-term physical impairment, whereas that within the somatotropic axis may be a compensatory protective response. Whether targeting of the residual abnormality in the thyroid axis may improve long-term physical outcome of the patients remains to be investigated. Trial registration ClinicalTrials.gov: NCT00512122, registered on July 31, 2007 (https://www.clinicaltrials.gov/ct2/show/NCT00512122). Graphical Abstract

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Persisting neuroendocrine abnormalities and their association with physical impairment 5 years after critical illness

et al. 2021

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“…Even though there is growing interest in the psychological development of children with CHD [ 9 , 12 , 22 ], there is still a lack of relevant literature focusing exclusively on children with surgically corrected isolated VSDs. Previously, we compared psychological long-term outcomes between primary school-aged children (t1) who underwent surgery for a VSD in infancy and typically developing children, including assessment of maternal anxiety and proactive parenting behavior as potential moderators [ 50 , 51 ]. The aim of this follow-up study was to reinvestigate these children in adolescence (t2) to reveal potential changes in their psychological adjustments.…”

Section: Aims Of This Studymentioning

confidence: 99%

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Lang

Gerlach

Plank

et al. 2022

JCM

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Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6–9 years) to adolescence (10–14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times—when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients’ quality of life was increased and internalizing problems were decreased—proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

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“…Although high rate of spontaneous closure was satisfying, there was currently no simple and systematic way to predict spontaneous closure of VSD . Therefore, it was essential to find out predictors of spontaneous closure of VSD.…”

Section: Discussionmentioning

confidence: 99%

Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow‐up

Ren

Song

et al. 2019

Clinical Cardiology

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Aim To predict the spontaneous closure of ventricular septal defect (VSD) and assist pediatrician to manage VSD children. Methods Between January 2008 and December 2016, 132 children diagnosed with isolated VSD by echocardiography were enrolled. All participating children were followed‐up by echocardiography yearly until the closure of VSD or 6 years old. The clinical indicators and echocardiographic parameters of patients were collected. Statistically significant factors were used to establish a Logistic Regression model for predicting spontaneous closure of VSD. Receiver operating characteristic (ROC) analysis was used to assess the specificity and sensitivity of Logistic Regression model. Results Spontaneous closure occurred in 60% of all patients; 57% in perimembranous VSD (p‐VSD) and 64% in muscular VSD (m‐VSD) patients. Initial diagnosis age, defect size, aneurysms tissue of the ventricular membranous septum (ATVMS), pulmonary hypertension (PH), and left ventricular diastolic dimension (LVDD) were statistically significant. Defect size, ATVMS and LVDD were determined by the Logistic Regression model as representative factor. P‐VSD and m‐VSD model had areas under the ROC curves 0.854 and 0.898, respectively. Conclusion We inferred that defect size, ATVMS and LVDD were characteristic and representative predictors for spontaneous closure of VSD. And we summarized the prognostic factors and recommended a follow‐up criteria to assist the pediatrician managing VSD children.

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Long-term Associations of an Early Corrected Ventricular Septal Defect and Stress Systems of Child and Mother at Primary School Age

Cited by 6 publications

References 40 publications

Persisting neuroendocrine abnormalities and their association with physical impairment 5 years after critical illness

Persisting neuroendocrine abnormalities and their association with physical impairment 5 years after critical illness

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow‐up

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