Neurodevelopmental Outcome in Preschool Survivors of Complex Congenital Heart Disease: Implications for Clinical Practice

Brosig, Cheryl L.; Mussatto, Kathleen A.; Kuhn, Evelyn M.; Tweddell, James S.

doi:10.1016/j.pedhc.2006.03.008

Cited by 72 publications

(83 citation statements)

References 16 publications

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“…14 Cognitive function and academic function were similar between the groups. However, problems with visual-motor skills and behavior were more common in HLHS patients.…”

Section: Discussionmentioning

confidence: 84%

Neurodevelopmental outcomes in preschool survivors of the Fontan procedure

Gaynor

Ittenbach

Gerdes

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objective To compare neurodevelopmental (ND) outcomes of preschool survivors of the Fontan procedure with those of children with congenital heart disease (CHD) undergoing biventricular (BV) repair and to investigate predictors of ND outcome for those with single ventricle (SV) CHD, including hypoplastic left heart syndrome (HLHS). Methods ND outcomes were assessed at 4 years of age including cognition, visual-motor integration, behavior, social skills and academic achievement. Unadjusted outcomes were compared between the BV and SV patients. Predictors of ND outcome were assessed in the SV patients. Multiple-covariate models were evaluated using patient-related, operative, and post-operative covariates. Results ND evaluation was performed in 365 children, 112 after the Fontan [HLHS (n = 91), other SV (n = 21)] and 253 after BV repair. Compared to BV patients, the SV patients performed worse in terms of processing speed, inattention and impulsivity. Otherwise there were no significant differences between the groups for any domain. There was a trend toward lower performance for SV patients on visual motor integration. Outcomes for patients with HLHS were not worse than for other forms of functional SV. Patient factors were more important predictors of ND outcomes than were operative management variables. Conclusions In this cohort, unadjusted ND outcomes for preschool survivors of the Fontan procedure are similar to those for children with CHD undergoing BV repair for most domains. Among the Fontan patients, HLHS was not associated with worse outcomes compared to other forms of SV.

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“…14 Cognitive function and academic function were similar between the groups. However, problems with visual-motor skills and behavior were more common in HLHS patients.…”

Section: Discussionmentioning

confidence: 84%

Neurodevelopmental outcomes in preschool survivors of the Fontan procedure

Gaynor

Ittenbach

Gerdes

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Recent studies have shown that children with complex CHD have a significantly increased risk for DD in the areas of intelligence, [15][16][17]47,48 academic achievement, 5,16,17,48,49 language (development, expressive and receptive), 5,15,16,48,50,51 visual construction and perception, 5,16,49,[52][53][54][55] attention, 5,6,16,49,51,56 executive functioning, 51,57 fine motor skills, 15 …”

Section: Prevalence Of Dd In the Chd Populationmentioning

confidence: 99%

“…Multiple studies have identified an increased incidence of behavioral problems in adolescents with heart disease. 16,53,56,64,[211][212][213][214][215][216] Research has identified internalizing problems, particularly social withdrawal, anxiety, somatic complaints, and depressive symptoms, to be more common in older children with pediatric heart disease than in the general population. 62,64,135,198,211,213,214 Externalizing problems, most commonly attention deficits, and hyperactivity have also been identified in adolescents: however, these appear to be more prevalent in younger children with heart disease.…”

Section: Behaviormentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Marino¹,

Lipkin²,

Newburger³

et al. 2012

Circulation

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1,156

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Background— The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. Methods and Results— A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Conclusions— Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

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“…Older children with HLHS have been found to have intelligence quotient (IQ) scores within the low average range but to have higher rates of attention and learning problems, behavioral and emotional problems, visual-motor/visual-spatial deficits, and language difficulties than the normal population [6, 8, 10, 11, 14, 21, 22, 28, 38]. Because of these deficits, many of these children require special education services within the school setting.…”

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confidence: 99%

Neurodevelopmental Outcomes for Children With Hypoplastic Left Heart Syndrome at the Age of 5 Years

et al. 2013

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This study aimed to determine the neurodevelopmental (ND) outcome for children with hypoplastic left heart syndrome (HLHS) at early school age. English-speaking patients who underwent the Norwood procedure between 2000 and 2005 were eligible at 4–6 years of age for ND testing. Of the 72 eligible patients, 44 (61 %) agreed to participate, and 37 completed ND testing before the close of the study. Three subjects were excluded from analyses due to late stroke. The ND testing included intelligence, visual motor integration, memory and motor and language skills. Parents and teachers completed measures of behavior and attention problems. Subjects’ scores and parent/teacher ratings were converted to z-scores and compared with test norms. Higher scores on child measures represent better outcomes, whereas higher scores on parent and teacher rating scales indicate more problems. The average ND performance of the tested cohort fell within one standard deviation of the test norms for all measures. However, the subjects performed significantly lower than the test norms on measures of visual-motor integration, fine motor skills, memory, and word structure (z = −0.42 to −0.54; p < 0.005). On the parent and teacher completed measures, the subjects scored higher than the test norms on attention problems (z = 0.40–0.62; p < 0.005). Although the overall ND performance of the cohort was normal, the subjects showed relative weakness in visual motor and attention skills. Ongoing developmental monitoring of these children is recommended to guide interventions that may improve individual outcomes and to assess the impact of changes in clinical management strategies on functional outcomes.

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Neurodevelopmental Outcome in Preschool Survivors of Complex Congenital Heart Disease: Implications for Clinical Practice

Cited by 72 publications

References 16 publications

Neurodevelopmental outcomes in preschool survivors of the Fontan procedure

Neurodevelopmental outcomes in preschool survivors of the Fontan procedure

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Neurodevelopmental Outcomes for Children With Hypoplastic Left Heart Syndrome at the Age of 5 Years

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