Abstract
Children with congenital heart disease are at high risk for neurodevelopmental challenges. There is little known, however, about possible effects of changing cardiac status on neurodevelopmental profiles over time. We examined the developmental trajectory of neuropsychological skills in a child with congenital heart disease who underwent multiple procedures over the course of childhood and adolescence. Serial neuropsychological evaluation (ages 8, 10, 11, and 14), was used to determine how cognitive skills varied as a result of changing cardiac status, and showed a stable pattern of strengths, including reasoning, learning and memory, with weaknesses in attention/executive skills, processing speed, and fine motor skills. There was a steady, downward trend in some areas, such as sustained attention and flexibility, suggesting a slower trajectory of development. In other areas, including aspects of executive function, processing speed, and verbal retrieval, there was fluctuation of scores with changing cardiac status that recovered following intervention. The clinical utility of serial neuropsychological evaluation in monitoring the effects of changing cardiac status is discussed.
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References
American Academy of Pediatrics. (2016). Pediatric clinical practice guidelines & policies, 16th edition: A compendium of evidence-based research for pediatric practice. American Academy of Pediatrics.
Bellinger, D. C., Jonas, R. A., Rappaport, L. A., Wypij, D., Wernovsky, G., Kuban, K. C., & Strand, R. D. (1995). Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. The New England Journal of Medicine, 332(9), 549–555. https://doi.org/10.1056/NEJM199503023320901
Bellinger, D. C., Wypij, D., Kuban, K. C. K., Rappaport, L. A., Hickey, P. R., Wernovsky, G., & Newburger, J. W. (1999). Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation, 100(5), 526–532. https://doi.org/10.1161/01.CIR.100.5.526
Bellinger, D. C., Bernstein, J. H., Kirkwood, M. W., Rappaport, L. A., & Newburger, J. W. (2003). Visual-spatial skills in children after open-heart surgery. Journal of Developmental and Behavioral Pediatrics, 24(3), 169–179 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12806229
Benvenuti, S. M., Patron, E., Zanatta, P., Polesel, E., & Palomba, D. (2014). Preexisting cognitive status is associated with reduced behavioral functional capacity in patients 3 months after cardiac surgery: An extension study. General Hospital Psychiatry, 36, 368–374. https://doi.org/10.1016/j.genhosppsych.2014.02.009
Bratzke-Bauer, L. C., Pozehl, B. J., Paul, S. M., & Johnson, J. K. (2013). Neuropsychological patterns differ by type of left ventricle dysfunction in heart failure. Archives of Clinical Neuropsychology, 28, 114–124. https://doi.org/10.1093/arclin/acs101
Brosig, C., Mussatto, K., Hoffman, G. et al. (2013). Neurodevelopmental Outcomes for Children With Hypoplastic Left Heart Syndrome at the Age of 5 Years. Pediatr Cardiol 34, 1597–1604. https://doi.org/10.1007/s00246-013-0679-3
Calderon, J., Bonnet, D., Courtin, C., Concordet, S., Plumet, M.-H., & Angeard, N. (2010). Executive function and theory of mind in school-aged children after neonatal corrective cardiac surgery for transposition of the great arteries. Developmental Medicine and Child Neurology, 52(12), 1139–1144.
Cassidy, A. R., White, M. T., DeMaso, D. R., Newburger, J. W., & Bellinger, D. C. (2015). Executive function in children and adolescents with critical cyanotic congenital heart disease. Journal of the International Neuropsychological Society, 21(1), 34–49. https://doi.org/10.1017/S1355617714001027
Cassidy, A. R., White, M. T., DeMaso, D. R., Newburger, J. W., & Bellinger, D. C. (2016). Processing speed, executive function, and academic achievement in children with dextro-transposition of the great arteries: Testing a longitudinal developmental cascade model. Neuropsychology, 30(7), 874–885.
Cassidy, A. R., Ilardi, D., Bowen, S. R., et al. (2017a). Congenital heart disease: A primer for the pediatric neuropsychologist. Child Neuropsychology Journal on Normal and Abnormal Development in Childhood and Adolescence, 24, 1–44.
Cassidy, A. R., Newburger, J. W., & Bellinger, D. C. (2017b). Learning and memory in adolescents with critical biventricular congenital heart disease. Journal of The International Neuropsychological Society, 23, 627–639.
DeMaso, D. R., Calderon, J., Taylor, G. A., et al. (2017). Psychiatric disorders in adolescents with single ventricle congenital heart disease. Pediatrics, 139, 320162241. https://doi.org/10.1542/peds.2016-2241
Friedman, T., Choen, O., Ziser, A., Kerner, A., Bitton-Worms, K., & Bolotin, G. (2017). Emboli and cognitive state in surgical vs. transcatheter aortic valve replacement. Asian Cardiovascular and Thoracic Annals, 25(6), 425–431.
Fugate, J. E., Moore, S. A., Knopman, D. S., Claassen, D. O., Wijdicks, E. F. M., White, R. D., & Rabinstein, A. A. (2013). Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest. Neurology, 81, 40–45. https://doi.org/10.1212/WNL.0b013e318297ee7e
Ginty, A. T., Phillips, A. C., Der, G., Deary, I. J., & Carroll, D. (2011). Cognitive ability and simple reaction time predict cardiac reactivity in the West of Scotland Twenty-07 Study. Psychophysiology, 48, 1022–1027. https://doi.org/10.1111/j.1469-8986.2010.01164.x
Hoffman, J. I. E., & Kaplan, S. (2002). The incidence of congenital heart disease. Journal of the American College of Cardiology, 39(12), 1890–1900. https://doi.org/10.1016/S0735-1097(02)01886-7
Hoffman, G. M., Brosig, C. L., Bear, L. M., Tweddell, J. S., & Mussatto, K. A. (2016). Effect of intercurrent operation and cerebral oxygenation on developmental trajectory in congenital heart disease. Annals and Thoracic Surgery, 101(2), 708–716.
Hövels-Gürich, H. H., Bauer, S. B., Schnitker, R., Hinckeldey, K. W.-v., Messmer, B. J., Seghaye, M.-C., & Huber, W. (2008). Long-term outcome of speech and language in children after corrective surgery for cyanotic or acyanotic cardiac defects in infancy. European Journal of Paediatric Neurology, 12(5), 378–386. https://doi.org/10.1016/j.ejpn.2007.10.004
Marelli, A., Miller, S. P., Marino, B. S., Jefferson, A. L., & Newburger, J. W. (2016). Brain in congenital heart disease across the lifespan. Circulation, 133(20), 1951–1962. https://doi.org/10.1161/CIRCULATIONAHA.115.019881
Marino, B., Likpkin, P. H., Newburger, J. W., Peacock, G., Gerdes, M., Gaynor, J. W., Mussatto, K. A., … Mahle, W. T. (2012). Neurodevelopmental outcomes in children with congenital heart disease: Evaluation and management: A scientific statement from the American heart association. Circulation, 126(3), 1143-1172.
Reller, M. D., Strickland, M. J., Riehle-Colarusso, T., Mahle W. T., & Correa, A. (2008). Prevalence of congenital heart defects in Metropolitan Atlanta 1998-2005. The Journal of Pediatrics, 153(6), 807–813. https://doi.org/10.1016/j.jpeds.2008.05.059
Sanz, J. H., Berl, M. M., Armour, A. C., Wang, J., Cheng, Y. I., & Donofrio, M. T. (2017). Prevalence and pattern of executive dysfunction in school age children with congenital heart disease. Congenital Heart Disease, 12(2), 202–209. https://doi.org/10.1111/chd.12427
Schaefer, C., von Rhein, M., Knirsch, W., Huber, R., Natalucci, G., Caflisch, J., Landolt, M. A., & Latal, B. (2013). Neurodevelopmental outcome psychological adjustment and quality of life in adolescents with congenitalheart disease. Developmental Medicine & Child Neurology, 55(12), 1143–1149. https://doi.org/10.1111/dmcn.12242
Shillingford, A. J., Glanzman, M. M., Ittenbach, R. F., Clancy, R. R., Gaynor, J. W., & Gil, W. (2008). Inattention hyperactivity and school performance in a population of school-age children with complex congenital heart disease. Pediatrics, 121(4), e759–e767. https://doi.org/10.1542/peds.2007-1066
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Greenbaum, H., Sanz, J.H., Donofrio, M.T. et al. Neurodevelopmental Trajectory in a Child with Congenital Heart Disease. J Pediatr Neuropsychol 9, 42–45 (2023). https://doi.org/10.1007/s40817-022-00121-5
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DOI: https://doi.org/10.1007/s40817-022-00121-5