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Provost S, Fourdain S, Vannasing P, Tremblay J, Roger K, Caron-Desrochers L, Hüsser A, Paquette N, Doussau A, Poirier N, Simard MN, Gallagher A. Language brain responses and neurodevelopmental outcome in preschoolers with congenital heart disease: A fNIRS study. Neuropsychologia 2024; 196:108843. [PMID: 38423173 DOI: 10.1016/j.neuropsychologia.2024.108843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
Neurodevelopmental disabilities affect up to 50% of survivors of congenital heart disease (CHD). Language difficulties are frequently identified during preschool period and can lead to academic, social, behavioral, and emotional difficulties. Structural brain alterations are associated with poorer neurodevelopmental outcomes in patients with CHD during infancy, childhood, and adolescence. However, evidence is lacking about the functional brain activity in children with CHD and its relationship with neurodevelopment. This study therefore aimed to characterize brain responses during a passive story-listening task in 3-year-old children with CHD, and to investigate the relationship between functional brain patterns of language processing and neurodevelopmental outcomes. To do so, we assessed hemodynamic concentration changes, using functional near-infrared spectroscopy (fNIRS), and neurodevelopmental outcomes, using the Wechsler Preschool and Primary Scale of Intelligence - 4th Edition (WPPSI-IV), in children with CHD (n = 19) and healthy controls (n = 23). Compared to their healthy peers, children with CHD had significantly lower scores on the Verbal comprehension index (VCI), the Vocabulary acquisition index (VAI), the General ability index (GAI), and the Information and the Picture Naming subtests of the WPPSI-IV. During the passive story-listening task, healthy controls showed significant hemodynamic brain responses in the temporal and the temporal posterior regions, with stronger activation in the temporal posterior than in the temporal regions. In contrast, children with CHD showed reduced activation in the temporal posterior regions compared to controls, with no difference of activation between regions. Reduced brain responses in the temporal posterior regions were also correlated with lower neurodevelopmental outcomes in both groups. This is the first study that reveals reduced brain functional responses in preschoolers with CHD during a receptive language task. It also suggests that the temporal posterior activation could be a potential brain marker of cognitive development. These findings provide support for the feasibility of identifying brain correlates of neurodevelopmental vulnerabilities in children with CHD.
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Affiliation(s)
- Sarah Provost
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Solène Fourdain
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Phetsamone Vannasing
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Julie Tremblay
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Kassandra Roger
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Laura Caron-Desrochers
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Alejandra Hüsser
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Natacha Paquette
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Nancy Poirier
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada; Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montréal, QC, Canada; Department of Surgery, Division of Cardiac Surgery, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Noëlle Simard
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Anne Gallagher
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.
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Provost S, Fourdain S, Vannasing P, Tremblay J, Roger K, García-Puente Y, Doussau A, Vinay MC, Von Siebenthal Z, Paquette N, Poirier N, Gallagher A. Relationship between 4-month functional brain network topology and 24-month neurodevelopmental outcome in children with congenital heart disease. Eur J Paediatr Neurol 2023; 47:47-59. [PMID: 37729706 DOI: 10.1016/j.ejpn.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Survivors of complex forms of congenital heart disease (CHD)∗ are at high risk of neurodevelopmental disabilities. Neuroimaging studies have pointed to brain anomalies and immature networks in infants with CHD, yet less is known about their functional network topology and associations with neurodevelopment. To characterize the functional network topology in 4-month-old infants with repaired CHD, we compared graph theory metrics measured using resting-state functional near-infrared spectroscopy (rs-fNIRS) between infants with CHD (n = 22) and healthy controls (n = 30). We also investigated the moderating effect of graph theory metrics on the relationship between group (CHD vs. Controls) and developmental outcomes at 24 months. At 4 months, both groups presented similar functional brain network topology. At 24 months, children with CHD had lower scores on the language scale and the expressive communication subscale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), as well as lower scores on the Grammatical Form scale of the MacArthur-Bates Communicative Development Inventory (MBCDI). The relationship between group and expressive language was moderated by the normalized characteristic path length (λ) and the degree (k). Although infants with CHD have functional brain topology similar to that of healthy controls, our findings suggest that they do not benefit from an optimal functional brain organization in comparison with healthy infants.
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Affiliation(s)
- Sarah Provost
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Solène Fourdain
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Phetsamone Vannasing
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Julie Tremblay
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Kassandra Roger
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | | | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Zorina Von Siebenthal
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Natacha Paquette
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Nancy Poirier
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Anne Gallagher
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.
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Ehrler M, Bellinger DC, Cassidy AR, Newburger JW, Calderon J. Social cognition and behavioral outcomes in congenital heart disease: profiles and neuropsychiatric comorbidities. Child Neuropsychol 2023; 29:1041-1063. [PMID: 37017255 DOI: 10.1080/09297049.2023.2196398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Autism spectrum disorders are more prevalent in children with congenital heart disease (CHD) than in the general population. Children with CHD without diagnosed autism are also at increased risk for neurodevelopmental and psychiatric impairments. We characterized social and behavioral outcomes in children with CHD and examined neurodevelopmental and psychiatric comorbidities. Children without diagnosed autism who underwent infant open-heart surgery were eligible. Parent-reports assessed social communication, unusual behaviors, self-regulation, anxiety, and executive function (EF). Neuropsychological tests assessing theory of mind (ToM), working memory, and verbal comprehension were administered. Outcomes were compared to normative data. Linear regressions were estimated with parent-reported scores and ToM abilities as outcomes. Predictors were anxiety symptoms, parent-reported EF, and working memory scores. Covariates were age, parental education, ADHD diagnosis, and verbal comprehension. Clinically relevant comorbidities were identified (N children scoring ≥1SD below the norm). Fifty-six children (10.8 ± 1.8 years) participated virtually. Compared to norms, children with CHD had impaired ToM, more unusual behaviors (p = .002), and less self-regulation (p = .018), but better social communication (p = .014). "Autism-like" traits were positively associated with anxiety symptoms (ß(95% CI) = 0.28(0.08-0.49), p = .008) and worse working memory (ß(95% CI) = -0.36(-0.59-0.13), p = .003). Twenty-one out of 22 children who displayed clinically relevant social and behavioral scores also showed anxiety symptoms (n = 4), impaired EF (n = 7), or both (n = 10). Children with CHD without diagnosed autism have elevated unusual behaviors, lower self-regulation, and impaired ToM. There is a high risk of co-existing anxiety and impaired EF which may increase disease burden. Targeted therapeutic interventions are needed to reduce long-term psychosocial risks in these children.AbbreviationAttention deficit/hyperactivity disorder (ADHD), Autism Spectrum Rating Scale (ASRS), Behavior Rating Inventory of Executive Functions for school-aged children, 2nd Edition (BRIEF-2), cardiopulmonary bypass (CPB), congenital heart disease (CHD), Empathy/Systematizing Quotient Child Version (ESQ-C), Multidimensional Anxiety Scale for Children, 2nd Edition (MASC-2), Social Responsiveness Scale (School-age form), 2nd Edition (SRS-2), theory of mind (ToM), Theory of Mind Task Battery (ToM-TB), Wechsler Intelligence Scale for Children, 5th edition (WISC-V).
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Departments of Cardiology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
| | - David C Bellinger
- Departments of Psychiatry, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Neurology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- Departments of Neurology, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Adam R Cassidy
- Departments of Psychiatry, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- Departments of Psychiatry and Psychology & Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jane W Newburger
- Departments of Cardiology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Pediatrics, Harvard Medical School, Harvard University, Boston, USA
| | - Johanna Calderon
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- National Institute of Health and Medical Research, Inserm U1046 PhyMedExp, Cardiac Neurodevelopment Research, University of Montpellier, Montpellier, France
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Wehrle FM, Furrer M, Feldmann M, Liamlahi R, Naef N, O'Gorman R, Latal B, Huber R. Functional networks of working memory abilities in children with complex congenital heart disease: a sleep EEG study. Child Neuropsychol 2023; 29:1109-1127. [PMID: 36324058 DOI: 10.1080/09297049.2022.2140796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Working memory is frequently impaired in children with complex congenital heart disease (CHD), but little is known about the functional neuronal correlates. Sleep slow wave activity (SWA; 1-4.5 Hz EEG power) has previously been shown to reliably map neurofunctional networks of cognitive abilities in children with and without neurodevelopmental impairments. This study investigated whether functional networks of working memory abilities are altered in children with complex CHD using EEG recordings during sleep. Twenty-one children with complex CHD (aged 10.9 [SD: 0.3] years) and 17 typically-developing peers (10.5 [0.7] years) completed different working memory tasks and an overnight high-density sleep EEG recording (128 electrodes). The combined working memory score tended to be lower in children with complex CHD (CHD group: -0.44 [1.12], typically-developing group: 0.55 [1.24], d = 0.59, p = .06). The working memory score and sleep SWA of the first hour of deep sleep were correlated over similar brain regions in both groups: Strong positive associations were found over prefrontal and fronto-parietal brain regions - known to be part of the working memory network - and strong negative associations were found over central brain regions. Within these working memory networks, the associations between working memory abilities and sleep SWA (r between -.36 and .58, all p < .03) were not different between the two groups (no interactions, all p > .05). The current findings suggest that sleep SWA reliably maps working memory networks in children with complex CHD and that these functional networks are generally preserved in these patients.
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Affiliation(s)
- Flavia M Wehrle
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neonatology and Intensive Care, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melanie Furrer
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maria Feldmann
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rabia Liamlahi
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nadja Naef
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ruth O'Gorman
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reto Huber
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Jassal YR, Kelly S, DiMaria M, Jacobsen R, Brigham D, Hawkins S, Rafferty C, Wolfe KR. Implications of attention and executive functioning weaknesses in youth with Fontan circulation. Child Neuropsychol 2023; 29:1021-1040. [PMID: 36082702 DOI: 10.1080/09297049.2022.2120191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
Youth with Fontan circulation (Fontan) are at-risk for impairments in attention and executive functioning (EF) due to a confluence of genetic, prenatal, surgical, and medical risk factors. We sought to describe attention and EF in this population, measured via standardized performance-based tests and caregiver rating scales. We then examined how weaknesses in attention and EF were related to outcomes in other neurobehavioral domains, including adaptive behavior and academic achievement. Our sample included 93 youth with Fontan who were referred for neuropsychological evaluations as part of standard clinical care. The cohort as a whole measured between 0.18 to 0.99 standard deviations below normative means across domains of attention, EF, academic achievement, and intellectual ability. In addition, caregiver-reported concerns for attention, EF, anxiety, and depression were elevated, and approximately 0.35 to 0.85 standard deviations above normative means. Lastly, caregiver-reported adaptive behavior measured 0.93 to 1.24 standard deviations below normative values. Academic outcomes were differentially affected by demographic and attention/EF variables, while depression and caregiver-reported EF predicted adaptive behavior. Findings from this study underscore the importance of routine neuropsychological evaluation as part of comprehensive, multidisciplinary care for individuals with Fontan, with the goal of enhancing neurobehavioral and functional outcomes across the lifespan.
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Affiliation(s)
- Yasmine R Jassal
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Kelly
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael DiMaria
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Roni Jacobsen
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dania Brigham
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephen Hawkins
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carey Rafferty
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Spillmann R, Polentarutti S, Ehrler M, Kretschmar O, Wehrle FM, Latal B. Congenital heart disease in school-aged children: Cognition, education, and participation in leisure activities. Pediatr Res 2023; 94:1523-1529. [PMID: 34853428 PMCID: PMC10589091 DOI: 10.1038/s41390-021-01853-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with congenital heart disease (CHD) are at risk for neurodevelopmental deficits. This study aimed to investigate the impact of cognitive deficits on educational outcome and participation in leisure activities. METHODS A prospective cohort of 134 children with CHD who underwent cardiopulmonary bypass surgery (CPB) was examined at 10 years of age. IQ was assessed with the WISC-IV and executive functions with the BRIEF (parent- and teacher-report). Parents reported on type and level of education and educational support, and leisure activity participation. Ordinal regression analyses assessed the association between cognitive deficits and educational outcome and participation. RESULTS Total IQ (P = 0.023), working memory (P < 0.001), processing speed (P = 0.008), and teacher-reported metacognition (P = 0.022) were lower than norms. Regular school was attended by 82.4% of children with CHD compared to 97% of the general Swiss population (P < 0.001). Seventy-five percent of children participated in leisure activities. Lower total IQ and teacher-rated global executive functions were associated with more educational support and lower IQ was associated with less participation. CONCLUSION As school-aged children with CHD experience cognitive deficits, follow-up is required to provide optimal support with regard to educational outcome and participation in leisure activities. IMPACT Contemporary cohorts of children with congenital heart disease undergoing cardiopulmonary bypass surgery remain at increased risk for cognitive deficits. Cognitive deficits affect educational outcome and leisure activities. These findings underline the importance of early detection of cognitive deficits and recommend support with respect to cognitive functioning.
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Affiliation(s)
- Rebecca Spillmann
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Susanne Polentarutti
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Department of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Flavia M Wehrle
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
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7
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Feldmann M, Borer J, Knirsch W, Daum MM, Wermelinger S, Latal B. Atypical gaze-following behaviour in infants with congenital heart disease. Early Hum Dev 2023; 181:105765. [PMID: 37079962 DOI: 10.1016/j.earlhumdev.2023.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Neurodevelopmental impairments are the most prevalent non-cardiac long-term sequelae in children with complex congenital heart disease (CHD). Deficits include the social-emotional and social-cognitive domains. Little is known about the predecessors of social-cognitive development in infants with CHD during the first year of life. Gaze-following behaviour can be used to measure early social-cognitive abilities. AIMS To assess gaze-following development in infants with CHD compared to healthy controls. STUDY DESIGN Prospective cohort study. PARTICIPANTS Twenty-three infants who underwent neonatal correction for CHD and 84 healthy controls. OUTCOME MEASURES Gaze-following behaviour was assessed by eye tracking at 6 and 12 months. Difference scores for first fixation, fixation frequency and fixation duration towards the gaze-cued object were calculated across 6 trials and compared between groups at both testing time points while adjusting for known confounders. Linear mixed models were calculated to assess the longitudinal trajectory of gaze-following development while accounting for the nested and dependent data structure. RESULTS At 6 months, no difference in gaze-following behaviour between CHD and healthy controls was found. At 12 months, fixation frequency towards the gaze-cued was lower and looking duration was shorter in CHD compared to controls (p = 0.0077; p = 0.0068). Infants with CHD showed less increase with age in the fixation frequency towards the congruent object (p = 0.041) compared to controls. CONCLUSION During the first year of life, gaze-following development diverges in infants with CHD compared to healthy controls. Further research is needed to investigate the clinical relevance of these findings and the association with later social-cognitive development.
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Affiliation(s)
- Maria Feldmann
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jessica Borer
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, Switzerland
| | - Moritz M Daum
- Department of Psychology, University of Zurich, Zurich, Switzerland; Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Stephanie Wermelinger
- Department of Psychology, University of Zurich, Zurich, Switzerland; Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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8
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Structural Racism, Social Determinants of Health, and Provider Bias: Impact on Brain Development in Critical Congenital Heart Disease. Can J Cardiol 2023; 39:133-143. [PMID: 36368561 DOI: 10.1016/j.cjca.2022.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Critical congenital heart disease (cCHD) has neurodevelopmental sequelae that can carry into adulthood, which may be due to aberrant brain development or brain injury in the prenatal and perinatal/neonatal periods and beyond. Health disparities based on the intersection of sex, geography, race, and ethnicity have been identified for poorer pre- and postnatal outcomes in the general population, as well as those with cCHD. These disparities are likely driven by structural racism, disparities in social determinants of health, and provider bias, which further compound negative brain development outcomes. This review discusses how aberrant brain development in cCHD early in life is affected by reduced access to quality care (ie, prenatal care and testing, postnatal care) due to divestment in non-White neighbourhoods (eg, redlining) and food insecurity, differences in insurance status, location of residence, and perceived interpersonal racism and bias that disproportionately affects pregnant people of colour who have fewer economic resources. Suggestions are discussed for moving forward with implementing strategies in medical education, clinical care, research, and gaining insight into the communities served to combat disparities and bias while promoting cultural humility.
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Neurodevelopmental Trajectory in a Child with Congenital Heart Disease. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022. [DOI: 10.1007/s40817-022-00121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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10
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Ziegler A, Chung WK. Recent advances in understanding neuro. Curr Opin Genet Dev 2022; 75:101938. [DOI: 10.1016/j.gde.2022.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
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Majeed A, Rofeberg V, Bellinger DC, Wypij D, Newburger JW. Machine Learning to Predict Executive Function in Adolescents with Repaired d-Transposition of the Great Arteries, Tetralogy of Fallot, and Fontan Palliation. J Pediatr 2022; 246:145-153. [PMID: 35314155 DOI: 10.1016/j.jpeds.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify predictors of impaired executive function in adolescents after surgical repair of critical congenital heart disease (CHD). STUDY DESIGN We analyzed patient factors, medical and surgical history, and family social class from 3 single-center studies of adolescents with d-transposition of the great arteries (d-TGA), tetralogy of Fallot (TOF), and Fontan repair. Machine learning models were developed using recursive partitioning to predict an executive function composite score based on five subtests (population mean 10, SD 3) of the Delis-Kaplan Executive Function System. RESULTS The sample included 386 patients (139 d-TGA, 91 TOF, 156 Fontan) of age 15.1 ± 2.1 (mean ± SD) years and an executive function composite score of 8.6 ± 2.4. Family social class emerged as the most important predictive factor. The lowest (worst) mean executive function score (5.3) occurred in patients with low to medium social class (Hollingshead index <56) with one or more neurologic events and a diagnosis of TOF. The highest (best) mean score (9.7) occurred in subjects with high social class (Hollingshead index ≥56) and shorter duration of deep hypothermic circulatory arrest. Other factors predicting lower executive function scores included low birth weight and a greater number of catheterizations. CONCLUSIONS In regression tree modeling, family social class was the strongest predictor of executive function in adolescents with critical CHD, even in the presence of medical risk factors. Additional predictors included CHD diagnosis, birth weight, neurologic events, and number of procedures. These data highlight the importance of social class in mitigating risks of executive dysfunction in CHD.
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Affiliation(s)
- Amara Majeed
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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12
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Dextro-Transposition of Great Arteries and Neurodevelopmental Outcomes: A Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040502. [PMID: 35455546 PMCID: PMC9027469 DOI: 10.3390/children9040502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
Abstract
Background: Arterial switch operation (ASO) is the gold-standard surgical approach for dextro-transposition of the great arteries (D-TGA). It is performed during the neonatal period and has almost diminished the previously high mortality rate (from 90% if left untreated to <0.5%). Despite the impressively high survival rates, the surgical procedure itself—along with the chronic post-operative complications and the perinatal impaired cerebral oxygen delivery—introduces multiple and cumulative risk factors for neurodevelopmental impairment. Method: This study is a review of English articles, using PUBMED and applying the following search terms, “transposition of the great arteries”, “neurodevelopment”, “autism”, “cerebral palsy”, and “attention-deficit hyperactivity disorder”. Data were extracted by two authors. Results: Even though general IQ is mainly found within the normal range, D-TGA children and adolescents display reduced performance in the assignments of executive functions, fine motor functions, attention, working memory, visual−spatial skills, and higher-order language skills. Moreover, D-TGA survivors may eventually struggle with inferior academic achievements and psychiatric disorders such as depression, anxiety, and ADHD. Conclusions: The existing literature concerning the neurodevelopment of D-TGA patients suggests impairment occurring during their lifespan. These findings underline the importance of close developmental surveillance so that D-TGA patients can better reach their full potential.
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13
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Calderon J, Newburger JW, Rollins CK. Neurodevelopmental and Mental Health Outcomes in Patients With Fontan Circulation: A State-of-the-Art Review. Front Pediatr 2022; 10:826349. [PMID: 35356444 PMCID: PMC8959547 DOI: 10.3389/fped.2022.826349] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Children, adolescents and adults living with Fontan circulation face numerous neurological and developmental challenges. As the population with complex CHD increases thanks to outstanding improvement in medical and surgical care, the long-term developmental and mental health sequelae have become a public health priority in pediatric and congenital cardiology. Many patients with a Fontan circulation experience difficulty in areas of cognition related to attention and executive functioning, visual spatial reasoning and psychosocial development. They are also at high risk for mental health morbidities, particularly anxiety disorders and depression. Several hemodynamic risk factors, beginning during the fetal period, may influence outcomes and yield to abnormal brain growth and development. Brain injury such as white matter lesions, stroke or hemorrhage can occur before, during, or after surgery. Other sociodemographic and surgical risk factors such as multiple catheterizations and surgeries and prolonged hospital stay play a detrimental role in patients' neurodevelopmental prognosis. Prevention and intervention to optimize long-term outcomes are critical in the care of this vulnerable population with complex CHD.
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Affiliation(s)
- Johanna Calderon
- PhyMedExp, Université de Montpellier, National Institute of Health and Medical Research (INSERM), CNRS, Montpellier, France.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Caitlin K Rollins
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States
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14
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Kobayashi K, Liu C, Jonas RA, Ishibashi N. The Current Status of Neuroprotection in Congenital Heart Disease. CHILDREN 2021; 8:children8121116. [PMID: 34943311 PMCID: PMC8700367 DOI: 10.3390/children8121116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.
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Affiliation(s)
- Kei Kobayashi
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Christopher Liu
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Richard A. Jonas
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
- School of Medicine and Health Science, George Washington University, Washington, DC 20052, USA
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
- School of Medicine and Health Science, George Washington University, Washington, DC 20052, USA
- Correspondence:
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15
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Abstract
CONTEXT People with CHD are at increased risk for executive functioning deficits. Meta-analyses of these measures in CHD patients compared to healthy controls have not been reported. OBJECTIVE To examine differences in executive functions in individuals with CHD compared to healthy controls. DATA SOURCES We performed a systematic review of publications from 1 January, 1986 to 15 June, 2020 indexed in PubMed, CINAHL, EMBASE, PsycInfo, Web of Science, and the Cochrane Library. STUDY SELECTION Inclusion criteria were (1) studies containing at least one executive function measure; (2) participants were over the age of three. DATA EXTRACTION Data extraction and quality assessment were performed independently by two authors. We used a shifting unit-of-analysis approach and pooled data using a random effects model. RESULTS The search yielded 61,217 results. Twenty-eight studies met criteria. A total of 7789 people with CHD were compared with 8187 healthy controls. We found the following standardised mean differences: -0.628 (-0.726, -0.531) for cognitive flexibility and set shifting, -0.469 (-0.606, -0.333) for inhibition, -0.369 (-0.466, -0.273) for working memory, -0.334 (-0.546, -0.121) for planning/problem solving, -0.361 (-0.576, -0.147) for summary measures, and -0.444 (-0.614, -0.274) for reporter-based measures (p < 0.001). LIMITATIONS Our analysis consisted of cross-sectional and observational studies. We could not quantify the effect of collinearity. CONCLUSIONS Individuals with CHD appear to have at least moderate deficits in executive functions. Given the growing population of people with CHD, more attention should be devoted to identifying executive dysfunction in this vulnerable group.
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16
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Neurodevelopmental Outcome of Children with Congenital Heart Disease: A Cohort Study from Infancy to Preschool Age. J Pediatr 2021; 239:126-135.e5. [PMID: 34454950 DOI: 10.1016/j.jpeds.2021.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize the neuropsychological outcome of children with congenital heart disease (CHD) at age 5 years; the stability of cognitive and language abilities across childhood; and to identify early neurodevelopmental markers of neuropsychological outcomes in these children. STUDY DESIGN Five-year-old children (n = 55) with complex CHD were assessed using standardized and comprehensive neuropsychological measures. Stability of language and cognitive performance was assessed by comparing standardized scores between ages 1, 2, and 5 years old. Association between 5-year-old skills and scores obtained in early childhood was studied to identify potential early markers of preschool performance. Receiver operating characteristic curves were used to evaluate the classification accuracy of Bayley Scales of Infant Development, Third Edition scales in identifying later impairments. RESULTS At age 5 years, our cohort obtained scores significantly below the norms on most developmental domains, with 35% to 65% of participants showing impaired short-term/working memory, attention, and preacademic skills. Developmental patterns measured between ages 1 and 5 years were different for cognitive and language domains, with a decline with age for cognitive functioning and stable results for expressive language. The Bayley Scales of Infant Development, Third Edition language scores at age 2 years provided a good predictive value in identifying children with impaired language at age 5 years. CONCLUSIONS In our cohort, we found a high prevalence of impairments affecting higher-order cognitive domains. Although language difficulties can be detected as early as 2 years of age, other neuropsychological impairments, such as attention and pre-academic skills, only appear later during development, which reinforces the need for long-term monitoring and systematic assessment before school entry.
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17
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Long-Term Neurodevelopmental Outcomes of Children with Congenital Heart Defects. J Pediatr 2021; 237:109-114.e5. [PMID: 34157347 DOI: 10.1016/j.jpeds.2021.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess whether children with symptomatic congenital heart defects (CHDs) at birth (cyanosis and/or heart failure) are at greater risk of adverse neurodevelopmental outcomes at 8 years of age. STUDY DESIGN From a prospective population-based cohort study of newborns with CHDs (EPICARD), we included 473 children with available neurodevelopmental assessments at 8 years of age. We grouped the CHD based on symptoms at birth and need for early neonatal intervention. Ventricular septal defects that closed spontaneously within the first year of life were considered the control group. Neurodevelopmental outcomes were assessed using the Kauffman Assessment Battery Test for Children, Second Edition, for IQ (mean 100 ± 15), and the Developmental NEuroPSYchological Assessment Battery, Second Edition, for detailed assessment of specific neurocognitive domains (mean 10 ± 3). Multivariable regression analysis was used to compare the outcomes across the CHD groups after considering potentially confounding variables. RESULTS Compared with the control group, children with cyanotic CHD without heart failure had lower scores for IQ, -7.2 (95% CI -13.4 to -1.2). Children with noncyanotic CHD with heart failure had lower scores in the specific domains of language -1.5 (95% CI -2.2 to -0.7), and memory and learning -1.3 (95% CI -2.4; -0.3). Those with both cyanotic CHD and heart failure had lower scores for IQ, -7.6 (95% CI -13.5 to -1.8), as well as the specific domains of language and memory and learning, -2.0 (95% CI -2.9 to -1.0) and -1.1 (95% CI -2.3 to -0.1), respectively. CONCLUSIONS Children with symptomatic CHD at birth are at greater risk of adverse neurodevelopmental outcomes at 8 years of age, with the greatest risk for those who were born with both cyanosis and heart failure.
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18
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Feldmann M, Bataillard C, Ehrler M, Ullrich C, Knirsch W, Gosteli-Peter MA, Held U, Latal B. Cognitive and Executive Function in Congenital Heart Disease: A Meta-analysis. Pediatrics 2021; 148:peds.2021-050875. [PMID: 34561266 DOI: 10.1542/peds.2021-050875] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Cognitive function and executive function (EF) impairments contribute to the long-term burden of congenital heart disease (CHD). However, the degree and profile of impairments are insufficiently described. OBJECTIVE To systematically review and meta-analyze the evidence on cognitive function and EF outcomes in school-aged children operated for CHD and identify the risk factors for an unfavorable outcome. DATA SOURCES Cochrane, Embase, Medline, and PsycINFO. STUDY SELECTION Original peer-reviewed studies reporting cognitive or EF outcome in 5- to 17-year old children with CHD after cardiopulmonary bypass surgery. DATA EXTRACTION Results of IQ and EF assessments were extracted, and estimates were transformed to means and SE. Standardized mean differences were calculated for comparison with healthy controls. RESULTS Among 74 studies (3645 children with CHD) reporting total IQ, the summary estimate was 96.03 (95% confidence interval: 94.91 to 97.14). Hypoplastic left heart syndrome and univentricular CHD cohorts performed significantly worse than atrial and ventricular septum defect cohorts (P = .0003; P = .027). An older age at assessment was associated with lower IQ scores in cohorts with transposition of the great arteries (P = .014). Among 13 studies (774 children with CHD) reporting EF compared with controls, the standardized mean difference was -0.56 (95% confidence interval: -0.65 to -0.46) with no predilection for a specific EF domain or age effect. LIMITATIONS Heterogeneity between studies was large. CONCLUSIONS Intellectual impairments in CHD are frequent, with severity and trajectory depending on the CHD subtype. EF performance is poorer in children with CHD without a specific EF profile. The heterogeneity in studied populations and applied assessments is large. A uniform testing guideline is urgently needed.
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Affiliation(s)
- Maria Feldmann
- Child Development Centre and Children's Research Centre.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Célina Bataillard
- Child Development Centre and Children's Research Centre.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Melanie Ehrler
- Child Development Centre and Children's Research Centre.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cinzia Ullrich
- Child Development Centre and Children's Research Centre.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Pediatric Cardiology, Pediatric Heart Center, and
| | | | - Ulrike Held
- Department of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Centre and Children's Research Centre .,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
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19
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Performance on the ROCF at 8 Years Predicts Academic Achievement at 16 Years in Individuals with Dextro-Transposition of the Great Arteries. J Int Neuropsychol Soc 2021; 27:857-864. [PMID: 33441211 PMCID: PMC8277877 DOI: 10.1017/s1355617720001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study examined longitudinal associations between performance on the Rey-Osterrieth Complex Figure-Developmental Scoring System (ROCF-DSS) at 8 years of age and academic outcomes at 16 years of age in 133 children with dextro-transposition of the great arteries (d-TGA). METHOD The ROCF-DSS was administered at the age of 8 and the Wechsler Individual Achievement Test, First and Second Edition (WIAT/WIAT-II) at the ages of 8 and 16, respectively. ROCF-DSS protocols were classified by Organization (Organized/Disorganized) and Style (Part-oriented/Holistic). Two-way univariate (ROCF-DSS Organization × Style) ANCOVAs were computed with 16-year academic outcomes as the dependent variables and socioeconomic status (SES) as the covariate. RESULTS The Organization × Style interaction was not statistically significant. However, ROCF-DSS Organization at 8 years was significantly associated with Reading, Math, Associative, and Assembled academic skills at 16 years, with better organization predicting better academic performance. CONCLUSIONS Performance on the ROCF-DSS, a complex visual-spatial problem-solving task, in children with d-TGA can forecast academic performance in both reading and mathematics nearly a decade later. These findings may have implications for identifying risk in children with other medical and neurodevelopmental disorders affecting brain development.
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20
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Abstract
Most children with congenital heart disease (CHD) survive to adulthood, owing largely to significant advances in the diagnosis and management of CHD over the past few decades. Primary care providers are essential partners in the recognition and management of these patients in our current medical environment. This article reviews the role of the primary care physician in detecting fetuses, infants, and children with possible CHD. Furthermore, this article discusses common primary care issues arising for patients with CHD, including growth and development, mental illness, dental care, and the transition to adult primary care.
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Affiliation(s)
- Michael Scott
- Department of Pediatrics, University of Louisville, Office of Medical Education, School of Medicine, 571 South Floyd, Suite 412, Louisville, KY 40202, USA
| | - Ashley E Neal
- Department of Pediatrics, University of Louisville School of Medicine and Norton Children's, 571 South Floyd Street, Suite 113, Louisville, KY 40202, USA.
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21
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Ehrler M, Schlosser L, Brugger P, Greutmann M, Oxenius A, Kottke R, O'Gorman Tuura R, Latal B. Altered white matter microstructure is related to cognition in adults with congenital heart disease. Brain Commun 2021; 3:fcaa224. [PMID: 33501427 PMCID: PMC7811757 DOI: 10.1093/braincomms/fcaa224] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Adults with congenital heart disease are at risk for persisting executive function deficits, which are known to affect academic achievement and quality of life. Alterations in white -matter microstructure are associated with cognitive impairments in adolescents with congenital heart disease. This study aimed to identify microstructural alterations potentially associated with executive function deficits in adults with congenital heart disease. Diffusion tensor imaging and tract-based spatial statistics were conducted in 45 patients (18 females) and 54 healthy controls (26 females) aged 18-32 years. Fractional anisotropy of white matter diffusion was compared between groups and correlated with an executive function score, derived from an extensive neuropsychological test battery. Patients showed widespread bilateral reduction in fractional anisotropy (P < 0.05, multiple comparison corrected) compared to controls. Lower fractional anisotropy was driven by patients with moderate and severe defect complexity (compared to controls: P < 0.001). Executive function scores were lower in patients (P < 0.05) and associated with lower fractional anisotropy in the left superior corona radiata and the corticospinal tract (corrected P < 0.05). Our findings confirm alterations of white matter microstructure in adults with congenital heart disease, mainly in those patients of moderate to severe complexity. These alterations are associated with impairments in executive functioning. A better understanding of the neurocognitive deficits may help counselling and care of patients with congenital heart disease across their lifespan and have the potential to improve their outcome and quality of life.
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ladina Schlosser
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Neurology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Peter Brugger
- Department of Psychiatry, University Hospital Zurich, Zurich, Switzerland.,Rehabilitation Center Valens, Valens, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
| | - Angela Oxenius
- Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland.,Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ruth O'Gorman Tuura
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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22
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Calderon J, Wypij D, Rofeberg V, Stopp C, Roseman A, Albers D, Newburger JW, Bellinger DC. Randomized Controlled Trial of Working Memory Intervention in Congenital Heart Disease. J Pediatr 2020; 227:191-198.e3. [PMID: 32827526 DOI: 10.1016/j.jpeds.2020.08.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy of Cogmed Working Memory Training compared with the standard of care to improve executive function and social outcomes in adolescents with congenital heart disease (CHD) who underwent open-heart surgery in infancy and to identify factors associated with changes in outcomes following the intervention. STUDY DESIGN In a single-center, randomized controlled trial, adolescents (13-16 years) with CHD were randomly assigned to either Cogmed (home-based 45-minutes sessions for 5-8 weeks) or to a control group. The primary outcome was working memory. Secondary outcomes included inhibitory control and cognitive flexibility as well as parent-reported executive function, symptoms of attention deficit hyperactivity disorder, and social outcomes. All measures were assessed at baseline, post-treatment (1-3 weeks post-training) and at 3-month follow-up. Data were analyzed using an intention-to-treat approach. RESULTS Sixty adolescents with CHD participated (28 assigned to Cogmed). No improvement at the post-treatment or 3-month follow-up assessments was found for the primary outcome measure of working memory. Compared with the control group, participants assigned to the intervention demonstrated benefits in inhibitory control and attention at the 3-month follow-up (P = .02) and in parent-reported cognitive regulatory skills at post-treatment and 3-month follow-up (P = .02 and P = .04, respectively). Preterm birth, biventricular CHD, and history of attention deficit hyperactivity disorder diagnosis were associated with improved response to the intervention. CONCLUSIONS Cogmed intervention produced improvements in the self-regulatory control abilities of adolescents with CHD. The training did not enhance other areas of executive function or behavioral outcomes. Further studies are needed to evaluate the longer-term potential benefits to other domains. TRIAL REGISTRATION Clinicaltrials.gov: NCT02759263.
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Affiliation(s)
- Johanna Calderon
- Department of Psychiatry, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Christian Stopp
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | | | - Daniel Albers
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David C Bellinger
- Department of Psychiatry, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
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23
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Neurodevelopmental evaluation for school-age children with congenital heart disease: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2020; 30:1623-1636. [PMID: 33143766 DOI: 10.1017/s1047951120003546] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In 2012, the American Heart Association and the American Academy of Paediatrics released a scientific statement with guidelines for the evaluation and management of the neurodevelopmental needs of children with CHD. Decades of outcome research now highlight a range of cognitive, learning, motor, and psychosocial vulnerabilities affecting individuals with CHD across the lifespan. The number of institutions with Cardiac Neurodevelopmental Follow-Up Programmes and services for CHD is growing worldwide. This manuscript provides an expanded set of neurodevelopmental evaluation strategies and considerations for professionals working with school-age children with CHD. Recommendations begin with the referral process and access to the evaluation, the importance of considering medical risk factors (e.g., genetic disorders, neuroimaging), and the initial clinical interview with the family. The neurodevelopmental evaluation should take into account both family and patient factors, including the child/family's primary language, country of origin, and other cultural factors, as well as critical stages in development that place the child at higher risk. Domains of assessment are reviewed with emphasis on target areas in need of evaluation based on current outcome research with CHD. Finally, current recommendations are made for assessment batteries using a brief core battery and an extended comprehensive clinical battery. Consistent use of a recommended assessment battery will increase opportunities for research collaborations, and ultimately help improve the quality of care for families and children with CHD.
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24
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Suard C, Flori A, Paoli F, Loundou A, Fouilloux V, Sigaudy S, Michel F, Antomarchi J, Moceri P, Paquis-Flucklinger V, D’Ercole C, Bretelle F. Accuracy of prenatal screening for congenital heart disease in population: A retrospective study in Southern France. PLoS One 2020; 15:e0239476. [PMID: 33017437 PMCID: PMC7535055 DOI: 10.1371/journal.pone.0239476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/07/2020] [Indexed: 12/29/2022] Open
Abstract
Congenital heart diseases (CHDs) are the most common congenital malformations. The objective of our study was to evaluate the prenatal screening accuracy of congenital heart disease (CHD) in Southern France and to evaluate the impact of a prenatal diagnosis on pregnancies outcomes and neonatal outcomes. We performed a bicentric, retrospective observational study in the southern region over 4 years was conducted between 1 January 2014 and 31 December 2017. All foetuses and children under one year of age with CHD monitored in the UTHs (University Teaching Hospitals) in Marseille and Nice were included. CHD cases were divided into 3 groups: group 1, those with no possible options for anatomical repair; group 2, those with anatomical repair possibilities but that may require neonatal cardiologic management; and group 3, those with anatomical repair possibilities that do not require an emergency neonatal procedure. Among the 249070 deliveries during the study period, 677 CHD cases were included in the study. The overall prenatal screening rate was 71.5%. The screening rates were 97.8%, 63.6%, and 65.9% for groups 1, 2 and 3, respectively. Among group 2 CHD cases, 80% of the transpositions of the great arteries, 56% of the aortic coarctations, and 20% of the total anomalous pulmonary venous returns were detected during the prenatal period. A genetic anomaly was found in 16% of CHD cases. The overall mortality rate was 11.3% with a higher death rate in cases of prenatal screening (17.2% versus 2.1%; p < 0.001). However, when focusing only on children who died of CHD, prenatal screening did not create an impact (56.6% versus 100%, p = 0,140). Our data showed that the prenatal screening rate of CHD appears satisfactory in Southern France. Nevertheless, it could be improved for some CHD. This study did not find any benefit in terms of mortality from prenatal screening for CHD.
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Affiliation(s)
- Cornélie Suard
- Department of Gynecology and Obstetrics, Nord Hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France
- * E-mail:
| | - Audrey Flori
- Department of Gynecology, Nice Teaching Hospital, Nice, France
| | - Florent Paoli
- Pediatric Cardiology Service, Assistance Publique des Hopitaux de Marseille, Hôpital de la Timone Enfants, Marseille, France
| | - Anderson Loundou
- Department of Public Health, Medical Evaluation, Assistance Publique des Hôpitaux de Marseille, Aix- Marseille Université, Marseille France
| | - Virginie Fouilloux
- Department of Cardiac Surgery, Children’s Hospital La Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Sabine Sigaudy
- Department of Medical Genetics, Children’s Hospital La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
- CPDPN Timone-Conception, Marseille, France
| | - Fabrice Michel
- Department of Pediatric Intensive Care Unit, Assistance-Publique des Hôpitaux de Marseille, Hospital La Timone, Marseille, France
| | - Julie Antomarchi
- Department of Obstetrics and Gynecology, Nice Teaching Hospital, Nice, France
| | - Pamela Moceri
- Department of cardiology, Nice Teaching Hospital, Nice, France
| | - Véronique Paquis-Flucklinger
- Department of Medical Genetics, National Center for Mitochondrial diseases, Nice Teaching Hospital, Nice, France
| | - Claude D’Ercole
- Department of Gynecology and Obstetrics, Nord Hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France
- Department of Obstetrics and Gynecology, Conception hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France
- CPDPDN Timone Conception. Réseau Méditerranée (PACA Corse Monaco), Marseille, France
- IHU, IRD, Marseille, France
| | - Florence Bretelle
- Department of Gynecology and Obstetrics, Nord Hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France
- Department of Obstetrics and Gynecology, Conception hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France
- CPDPDN Timone Conception. Réseau Méditerranée (PACA Corse Monaco), Marseille, France
- IHU, IRD, Marseille, France
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Abstract
Most children born with even the most critical forms of CHD are now surviving well into adulthood. However, with increased survival has come increased recognition of the diverse neurobehavioural and psychosocial challenges these children experience. Among these challenges are deficits in executive function skills, including inhibitory control, working memory, and cognitive flexibility. Over the past several years, whereas inhibitory control and working memory deficits have garnered particular attention among clinicians and interventionists, relatively less attention has been paid to cognitive flexibility. This is unfortunate given both the high prevalence of cognitive flexibility deficits observed in children and adolescents with critical CHD, and also the far-reaching relevance of cognitive flexibility in helping individuals achieve optimal quality of life across the lifespan. This paper reviews the construct of cognitive flexibility, including its definition, development, measurement, and neuroanatomical basis, provides a summary of how cognitive flexibility is affected by CHD, and offers evidence-based recommendations to systematically support the development of cognitive flexibility within the context of CHD.
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Abstract
INTRODUCTION While the overall prevalence of autism is 1.7% in the United States of America, research has demonstrated a two- to five-fold increase in CHD. The Cardiac Neurodevelopmental Outcome Collaborative recommends screening for autism from infancy through adolescence. This study investigated the frequency of autism concerns at a single Cardiac Neurodevelopmental Program and examined current clinical practice as a way to improve quality of care. MATERIALS AND METHODS Patients (n = 134; mean age = 9.0 years) included children with high-risk CHD who completed a neurodevelopmental evaluation following a formalised referral to the Cardiac Neurodevelopmental Program between 2018 and 2019. Retrospective chart review included parent report on the Behaviour Assessment System for Children-3 and Adaptive Behaviour Assessment System-3. Descriptive and correlation analyses were completed. RESULTS In this sample, 11.2% presented with autism-related concerns at referral, 2 were diagnosed with autism, 9 were referred to an autism specialist (6 confirmed diagnosis; 3 not completed). Thus, at least 5.9% of the sample were diagnosed with autism following thorough clinical evaluation. Analyses showed atypicality, along with deficient adaptability, leisure, social, and communication skills. Frequency of early intervention, school supports, and relation with comorbidities are reported. DISCUSSION Prior to assessment recommendations by the Cardiac Neurodevelopmental Outcome Collaborative, autism screening may not be completed systematically in clinical care for CHD. The current sample demonstrates a high frequency of autism in the typically referred clinical sample. Commonly used parent-report measures may reveal concerns but will not help diagnosis. Systematic use of an autism screener is essential.
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Asschenfeldt B, Evald L, Heiberg J, Salvig C, Østergaard L, Dalby RB, Eskildsen SF, Hjortdal VE. Neuropsychological Status and Structural Brain Imaging in Adults With Simple Congenital Heart Defects Closed in Childhood. J Am Heart Assoc 2020; 9:e015843. [PMID: 32427039 PMCID: PMC7428999 DOI: 10.1161/jaha.120.015843] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Neurodevelopmental impairments are common in survivors of complex congenital heart defects (CHD). We report neuropsychological and brain imaging assessments in adults operated for isolated septal defects. Methods and Results Patients (mean age 25.6 yrs) who underwent childhood surgery for isolated atrial septal defect (n=34) or ventricular septal defect (n=32), and healthy matched peers (n=40), underwent a standard battery of neuropsychological tests and a 3.0T brain magnetic resonance imaging scan. Patient intelligence was affected with lower scores on Full‐Scale intelligence quotient (P<0.001), Verbal Comprehension (P<0.001), Perceptual Reasoning (P=0.007), and Working Memory (P<0.001) compared with controls. Also, the CHD group had poorer visuospatial abilities (Immediate Recall, P=0.033; Delayed Recall, P=0.018), verbal memory (Trial 1, P=0.015; Total Learning, P<0.001; Delayed Recall, P=0.007), executive function (Executive Composite Score, P<0.001), and social recognition (Reading the Mind in the Eyes Test, P=0.002) compared with controls. Self‐reported levels of executive dysfunction, attention deficits and hyperactivity behavior, and social cognition dysfunction were higher in the CHD group compared with population means and controls. We found similar global and regional morphometric brain volumes and a similar frequency of brain magnetic resonance imaging abnormalities in the 2 groups. The CHD group had a high occurrence of psychiatric disease and a larger need for special teaching during school age. Conclusions Children operated for simple CHD demonstrate poorer neurodevelopmental outcomes in adulthood when compared with healthy controls and expected population means. REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03871881.
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Affiliation(s)
- Benjamin Asschenfeldt
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Lars Evald
- Department of Clinical Medicine Aarhus University Aarhus Denmark.,Hammel Neurorehabilitation Centre and University Research Clinic Hammel Denmark
| | - Johan Heiberg
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Camilla Salvig
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Aarhus N Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience Aarhus University Aarhus Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark.,Neuroradiology Research Unit Department of Radiology Aarhus University Hospital Aarhus N Denmark
| | - Rikke Beese Dalby
- Department of Radiology, Section of Neuroradiology Aarhus University Hospital Aarhus N Denmark
| | - Simon Fristed Eskildsen
- Center of Functionally Integrative Neuroscience Aarhus University Aarhus Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark
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Ehrler M, Latal B, Polentarutti S, von Rhein M, Held L, Wehrle FM. Pitfalls of using IQ short forms in neurodevelopmental disorders: a study in patients with congenital heart disease. Pediatr Res 2020; 87:917-923. [PMID: 31711070 DOI: 10.1038/s41390-019-0667-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/17/2019] [Accepted: 10/16/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Short forms of IQ (S-IQ) assessments are time efficient and highly predictive of the full IQ (F-IQ) in healthy individuals. To investigate the validity of S-IQs for patients with neurodevelopmental impairments, this study tested a well-established S-IQ version in patients with congenital heart disease (CHD). METHODS The Wechsler Intelligence Scale for Children, Fourth Edition was applied in 107 children with complex CHD aged 9-11 years. F-IQ and a well-established S-IQ version were calculated for each patient. The agreement between S-IQ and F-IQ was investigated across the whole spectrum of IQ scores. Finally, we tested a method to adjust IQs to resolve potential bias and validated this method in an independent sample of 55 CHD patients. RESULTS S-IQ and F-IQ correlated strongly. Nevertheless, the size of the bias correlated with the true IQ, indicating larger error at the tails of the distribution. Estimating a corrected IQ by adjusting the S-IQ with correction parameters substantially improved agreement. CONCLUSION We here report that substantial bias may underestimate low IQ scores and overestimate high ones. This bias should be considered when at-risk populations are assessed with S-IQs. Importantly, the bias can be minimized by using a correction formula.
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Susanne Polentarutti
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael von Rhein
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Developmental Pediatrics, SPZ, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Leonhard Held
- Department of Biostatistics, University of Zurich, Zurich, Switzerland
| | - Flavia M Wehrle
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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Altered frontal white matter microstructure is associated with working memory impairments in adolescents with congenital heart disease: A diffusion tensor imaging study. NEUROIMAGE-CLINICAL 2019; 25:102123. [PMID: 31869770 PMCID: PMC6933217 DOI: 10.1016/j.nicl.2019.102123] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022]
Abstract
Children and adolescents with congenital heart disease (CHD) are at risk for mild to moderate cognitive impairments. In particular, impaired working memory performance has been found in CHD patients of all ages. Working memory is an important domain of higher order cognitive function and is crucial for everyday activities, with emerging importance in adolescence. However, the underlying neural correlate of working memory impairments in CHD is not yet fully understood. Diffusion tensor imaging and tract based spatial statistics analyses were conducted in 47 adolescent survivors of childhood cardiopulmonary bypass surgery (24 females) and in 44 healthy controls (24 females) between 11 and 16 years of age (mean age = 13.9, SD = 1.6). Fractional anisotropy (FA) of white matter diffusion was compared between groups and was correlated with working memory performance, derived from the Wechsler Intelligence Scale for Children-IV. CHD patients had significantly poorer working memory compared to controls (p = 0.001). Widespread bilateral reduction in FA was observed in CHD patients compared to healthy controls (threshold-free cluster enhancement (TFCE) corrected p < 0.05). This reduction in FA was present both in cyanotic and acyanotic CHD patients compared to healthy controls (both p < 0.001). The FA reduction in the frontal lobe, mainly in the forceps minor, was associated with poorer working memory performance in both patients with CHD and healthy controls (TFCE corrected p < 0.05). The current findings underline that in CHD patients, irrespective of disease severity, disrupted or delayed maturation of white matter may persist into adolescence and is associated with working memory impairments, particularly if present in the frontal lobe. Adolescence, which is a crucial period for prefrontal brain maturation, may offer a window of opportunity for intervention in order to support the maturation of frontal brain regions and therefore improve higher order cognitive function in patients with CHD.
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30
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Phillips JM, Longoria JN. [Formula: see text] Addressing the neurodevelopmental needs of children and adolescents with congenital heart disease: A review of the existing intervention literature. Child Neuropsychol 2019; 26:433-459. [PMID: 31672097 DOI: 10.1080/09297049.2019.1682131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital heart disease (CHD) is among the most prevalent birth defects in the United States. Given that children with CHD are at risk for differences with development, learning, and psychosocial functioning, effective intervention becomes a central tenant of recommendations following neuropsychological consultation and evaluation. The primary focus of this review is to summarize available interventions for children and adolescents with CHD. The existing CHD literature has concentrated on early developmental services, psychopharmacological treatment, and need for academic supports. The literature is limited with regard to intervention studies that target cognitive deficits and psychosocial difficulties. To address this discrepancy, efficacious interventions that have been used to mitigate these concerns within other medical groups are also discussed in an effort to provide options for alternative recommendations and services. The current paper is intended to facilitate comprehensive care for cardiac patients by providing clinicians with a review of the available intervention literature, as well as potential interventions that may serve as supplemental strategies in the interim.
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Affiliation(s)
- Jannel M Phillips
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI, USA
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31
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Ehrler M, Naef N, Tuura RO, Latal B. Executive function and brain development in adolescents with severe congenital heart disease (Teen Heart Study): protocol of a prospective cohort study. BMJ Open 2019; 9:e032363. [PMID: 31666273 PMCID: PMC6830656 DOI: 10.1136/bmjopen-2019-032363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) is the most frequent congenital malformation. With recent advances in medical care, the majority of patients with CHD survive into adulthood. As a result, interest has shifted towards the neurodevelopmental outcome of these patients, and particularly towards the early detection and treatment of developmental problems. A variety of mild to moderate cognitive impairments as well as emotional and behavioural problems has been observed in this population. However, a more detailed assessment of the various domains of executive function and their association with structural and functional brain development is lacking. Therefore, the current study will examine all domains of executive function and brain development in detail in a large sample of children and adolescents with CHD and healthy control children. METHODS AND ANALYSIS A total of 192 children and adolescents with CHD aged 10-15 years, who participated in prospective cohort studies at the University Children's Hospital Zurich, will be eligible for this study. As a control group, approximately 100 healthy children will be enrolled. Primary outcome measures will include executive function abilities, while secondary outcomes will consist of other neurodevelopmental measures, including intelligence, processing speed, attention, fine motor abilities and brain development. An MRI will be performed to assess structural and functional brain development. Linear regression analyses will be applied to investigate group differences and associations between executive function performance and neurodevelopmental measures. ETHICS AND DISSEMINATION This study is supported by the Swiss National Science Foundation (SNF 32003B_172914) and approved by the ethical committee of the Canton Zurich (KEK 2019-00035). Written informed consent will be obtained from all the parents and from children aged 14 years or older. Findings from this study will be published in peer-reviewed journals and presented at national and international conferences for widespread dissemination of the results.
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children Hospital Zurich, Zurich, Switzerland
| | - Nadja Naef
- Child Development Center, University Children Hospital Zurich, Zurich, Switzerland
| | - Ruth O'Gorman Tuura
- MR Research Centre, University Children Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children Hospital Zurich, Zurich, Switzerland
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Chang LY, Chiu SN, Wang CC, Weng WC, Chang HY. Parenting stress mediates the association between cyanotic congenital heart disease and internalising problems in children and adolescents. Eur J Cardiovasc Nurs 2019; 19:301-309. [PMID: 31656087 DOI: 10.1177/1474515119881871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children and adolescents with cyanotic congenital heart disease have been found to be at an increased risk of internalising problems. The underlying mechanisms, however, remain uncertain. AIMS To examine the association between cyanotic congenital heart disease and internalising problems and assess whether parenting stress mediates this association. METHOD The study sample was 699 children and adolescents (aged 2-17 years) with congenital heart disease (253 with cyanotic congenital heart disease and 446 with acyanotic congenital heart disease) in Taiwan. The Child Behavior Checklist and the Parenting Stress Index were used to assess internalising problems and parenting stress, respectively. A series of multiple regression models was conducted using the SPSS PROCESS procedure to test the association between types of congenital heart disease and internalising problems and the mediating role of parenting stress. A bootstrapping approach was applied to determine the significance of mediation. RESULTS Compared with acyanotic congenital heart disease, cyanotic congenital heart disease was associated with increased levels of internalising problems (B=2.52, P<0.01), and this association was mediated by parenting stress (B=0.97, 95% bias-corrected bootstrap confidence interval 0.24, 1.75). In particular, parents of children with cyanotic congenital heart disease reported significantly more parenting stress compared with parents of children with acyanotic congenital heart disease (B=4.63, P<0.01), which contributed to elevated levels of internalising problems in the offspring (B=0.21, P<0.001). CONCLUSION Cyanotic congenital heart disease conferred risks for internalising problems in children and adolescents, and this association was mediated by parenting stress. Interventions to decrease internalising problems in children and adolescents with cyanotic congenital heart disease may be more effective by targeting parenting stress.
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Affiliation(s)
- Ling-Yin Chang
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Chia-Ching Wang
- Department of Pediatrics, Far Eastern Memorial Hospital, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
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Ryan KR, Jones MB, Allen KY, Marino BS, Casey F, Wernovsky G, Lisanti AJ. Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors. World J Pediatr Congenit Heart Surg 2019; 10:750-758. [PMID: 31658880 DOI: 10.1177/2150135119878702] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
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Affiliation(s)
- Kathleen R Ryan
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Melissa B Jones
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Kiona Y Allen
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Bradley S Marino
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Frank Casey
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - Gil Wernovsky
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Amy Jo Lisanti
- Department of Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-based Practice, Children's Hospital of Philadelphia, PA, USA
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Abstract
Prepotent response inhibition and temporal perception abilities were explored in a sample of individuals with cerebral palsy relative to typically developing peers. The extent to which inhibitory control difficulties might affect temporal processing was also investigated. For this purpose, two inhibitory control tasks and two duration estimation tasks were given to the groups of cerebral palsy and typically developing children. Results showed inhibition and temporal perception problems in the group with cerebral palsy. A relationship was found between inhibition and temporal estimation performances, which indicates that inhibitory control contributes, at least partially, to acquisition of the temporal processing ability.
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Affiliation(s)
- Mercedes Cabezas
- BOBATH Foundation.,National Distance Education University (UNED)
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35
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Venchiarutti M, Vergine M, Zilli T, Sommariva G, Gortan AJ, Crescentini C, Urgesi C, Fabbro F, Cogo P. Neuropsychological Impairment in Children With Class 1 Congenital Heart Disease. Percept Mot Skills 2019; 126:797-814. [DOI: 10.1177/0031512519856766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with congenital heart disease (CHD) are at increased risk of neuropsychological impairments, but few studies are available on the nonlinguistic neuropsychological abilities of children with CHD. We conducted neuropsychological evaluations using the NEPSY II on a cohort of 17 school-age Italian children with diagnoses of Class 1 CHD, no genetic or chromosomal abnormalities, and normal intelligence scores, and we compared them with 34 matched controls. Children with CHD in this study had undergone at least one cardiac surgery with cardiopulmonary bypass support. We found that children with CHD scored significantly lower than their matched controls on memory and learning domain tasks, and they displayed subtle attention/executive dysfunctions and deficits in sensorimotor skills.
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Affiliation(s)
- Martina Venchiarutti
- Division of Pediatric, Department of Medicine, University of Udine, Udine, Italy
| | - Michela Vergine
- Division of Pediatric, Department of Medicine, University of Udine, Udine, Italy
| | - Tiziana Zilli
- Scientific Institute Eugenio Medea, San Vito al Tagliamento (Pordenone), Italy
| | - Giulia Sommariva
- Division of Pediatric, Department of Medicine, University of Udine, Udine, Italy
| | - Anna Jolanda Gortan
- Division of Pediatric, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Cosimo Urgesi
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Franco Fabbro
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Perceptual Robotics (PERCRO) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paola Cogo
- Division of Pediatric, Department of Medicine, University of Udine, Udine, Italy
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Ladak LA, Hasan BS, Gullick J, Gallagher R. Health-related quality of life in congenital heart disease surgery in children and young adults: a systematic review and meta-analysis. Arch Dis Child 2019; 104:340-347. [PMID: 29572215 DOI: 10.1136/archdischild-2017-313653] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/17/2018] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND As survival improves in the congenital heart disease (CHD) population, health-related quality of life (HRQOL) outcomes become increasingly important. While surgery improves survival, poor HRQOL occurs postoperatively and cardiac-related HRQOL outcomes are rarely reported. OBJECTIVE To conduct a systematic review and meta-analyses of general and cardiac-related HRQOL in CHD surgical children and young adults. METHOD Medline, CINAHL and EMBASE were searched. Quantitative designs with a minimum of 80% CHD surgical patients and mean age ≤18 years compared with healthy controls were included in the review. Data were analysed in RevMan V.5.3 using a random effects model. OUTCOME MEASURES General and cardiac-related HRQOL. RESULTS Studies (n=20) were conducted in high-income countries and included 3808 patients plus 2951 parental reports of patients. HRQOL was worse in postoperative patients with CHD versus healthy controls in all domains with the largest difference seen for physical function (standard mean difference (SMD) of -0.56, 95% CI -0.82 to -0.30). Cardiac-related HRQOL was worse in complex compared with simple CHD with the largest SMD (-0.60, 95% CI -0.80 to -0.40) for symptoms. Heterogeneity ranged from 0% to 90%. CONCLUSIONS CHD surgical patients have substantially worse HRQOL compared with age-matched healthy controls. Strategies should focus on improving HRQOL in this subgroup. Results may not be applicable to low/middle-income countries given the dearth of relevant research.
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Affiliation(s)
- Laila Akbar Ladak
- Charles Perkins Centre, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Babar Sultan Hasan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Janice Gullick
- Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, The University of Sydney, Sydney, Australia
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Calderon J, Bellinger DC, Hartigan C, Lord A, Stopp C, Wypij D, Newburger JW. Improving neurodevelopmental outcomes in children with congenital heart disease: protocol for a randomised controlled trial of working memory training. BMJ Open 2019; 9:e023304. [PMID: 30782877 PMCID: PMC6377570 DOI: 10.1136/bmjopen-2018-023304] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/22/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Executive function (EF) impairments are among the most prevalent neurodevelopmental morbidities in youth with congenital heart disease (CHD). To date, no studies have investigated the efficacy of cognitive interventions to improve EF outcomes in children with CHD. METHODS AND ANALYSIS This is a single-centre, single-blinded, two-arm randomised controlled trial to test the efficacy of Cogmed Working Memory Training (Cogmed) versus standard of care in children with CHD after open-heart surgery in infancy. Participants will consist of 100 children with CHD aged 7-12 years who underwent open-heart surgery before the age of 12 months. Participants are randomly allocated to either an intervention group including training on the home-based Cogmed intervention for a duration of approximately 5 weeks or a control group who receive the standard of care. We will evaluate the efficacy of Cogmed at post-treatment and 3 months after completion of the intervention. Baseline, post-treatment and 3-month follow-up assessments will include specific measures of EF, cognitive and social functioning, and attention deficit hyperactivity disorder (ADHD) symptoms. The primary outcome of this study is the change in standardised mean score on the List Sorting Working Memory test from the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function. Secondary outcomes include measures of social skills, inhibitory control, cognitive flexibility and behavioural EF as well as ADHD symptoms as measured by the Behavior Rating Inventory of Executive Function, Second Edition, and the Conners Third Edition. The efficacy of the intervention will be evaluated by comparing within-subject differences (baseline to post-treatment, baseline to 3-month follow-up) between the two groups using an intention-to-treat analysis. ETHICS AND DISSEMINATION This study has received Institutional Review Board (IRB) approval from Boston's Children's Hospital IRB (P00022440) and the Human Protection Agency from the US Department of Defense. TRIAL REGISTRATION NUMBER NCT03023644; Pre-results.
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Affiliation(s)
- Johanna Calderon
- Boston Children’s Hospital, Department of Psychiatry, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - David C Bellinger
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine Hartigan
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Alison Lord
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Christian Stopp
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - David Wypij
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Lee KEM, Diacovo TG, Calderon J, Byrne MW, Ing C. Outcomes Research in Vulnerable Pediatric Populations. J Neurosurg Anesthesiol 2019; 31:140-143. [PMID: 30767939 PMCID: PMC9109709 DOI: 10.1097/ana.0000000000000544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Pediatric Anesthesia and Neurodevelopment Assessment (PANDA) study team held its biennial symposium in April 2018 to discuss issues on anesthetic neurotoxicity in the developing brain. One of the sessions invited speakers with different areas of expertise to discuss "Outcomes Research in Vulnerable Pediatric Populations." The vulnerable populations included neonates, children with congenital heart disease, children from low socioeconomic status, and children with incarcerated parents. Each speaker presented some of the ongoing research efforts in these groups as well as the challenges encountered in studying them.
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Affiliation(s)
- Ka-Eun M Lee
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons
| | - Thomas G Diacovo
- Departments of Pediatrics and Pharmacology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Johanna Calderon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Mary W Byrne
- Columbia University School of Nursing, Columbia University College of Physicians and Surgeons
| | - Caleb Ing
- Department of Anesthesiology and Epidemiology, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY
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Liamlahi R, Latal B. Neurodevelopmental outcome of children with congenital heart disease. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:329-345. [PMID: 31324319 DOI: 10.1016/b978-0-444-64029-1.00016-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Congenital heart disease (CHD) constitutes the most common congenital malformation, with moderate or severe CHD occurring in around 6 in 1000 live births. Due to advances in medical care, survival rates have increased significantly. Thus, the majority of children with CHD survive until adolescence and adulthood. Children with CHD requiring cardiopulmonary bypass surgery are at risk for neurodevelopmental impairments in various domains, including mild impairments in cognitive and neuromotor functions, difficulties with social interaction, inattention, emotional symptoms, and impaired executive function. The prevalence for these impairments ranges from 20% to 60% depending on age and domain ("high prevalence-low severity"). Domains are often affected simultaneously, leading to school problems with the need for learning support and special interventions. The etiology of neurodevelopmental impairments is complex, consisting of a combination of delayed intrauterine brain development and newly occurring perioperative brain injuries. Mechanisms include altered intrauterine hemodynamic flow as well as neonatal hypoxia and reduced cerebral blood flow. The surgical procedure and postoperative phase add to this cascade of factors interfering with normal brain development. Early identification of children at high risk through structured follow-up programs is mandated to provide individually tailored early interventions and counseling to improve developmental health.
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Affiliation(s)
- Rabia Liamlahi
- Child Development Center, University Children's Hospital Zürich, Zürich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zürich, Zürich, Switzerland.
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On the relation between theory of mind and executive functioning: A developmental cognitive neuroscience perspective. Psychon Bull Rev 2018; 25:2119-2140. [DOI: 10.3758/s13423-018-1459-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Angeard N, Huerta E, Jacquette A, Cohen D, Xavier J, Gargiulo M, Servais L, Eymard B, Héron D. Childhood-onset form of myotonic dystrophy type 1 and autism spectrum disorder: Is there comorbidity? Neuromuscul Disord 2018; 28:216-221. [DOI: 10.1016/j.nmd.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022]
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Kasmi L, Calderon J, Montreuil M, Geronikola N, Lambert V, Belli E, Bonnet D, Kalfa D. Neurocognitive and Psychological Outcomes in Adults With Dextro-Transposition of the Great Arteries Corrected by the Arterial Switch Operation. Ann Thorac Surg 2018; 105:830-836. [DOI: 10.1016/j.athoracsur.2017.06.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
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González-González G, Bernardo Pliego-Rivero F, Rodríguez-Camacho M, Mendieta Alcántara G, Otero Ojeda GA. Assessment of cognitive performance among Mexican children and adolescents afflicted by simple to complex congenital heart diseases. Preliminary study. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Calderon J, Willaime M, Lelong N, Bonnet D, Houyel L, Ballon M, Goffinet F, Khoshnood B. Population-based study of cognitive outcomes in congenital heart defects. Arch Dis Child 2018; 103:49-56. [PMID: 28780508 DOI: 10.1136/archdischild-2016-310830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterise and compare cognitive outcomes in children with operated (open-heart surgery) and non-operated (catheter-based interventions only or no intervention) congenital heart defects (CHD) and to determine associated risk factors. DESIGN This prospective population-based study reports outcomes of 3-year-old children with CHD with or without open-heart surgery. MAIN OUTCOME MEASURES Standardised cognitive scores (mean scores and proportions below normative values) were assessed with the Kaufman Assessment Battery for Children II. We analysed demographic, perinatal and operative variables as predictors of cognitive outcomes. RESULTS 419 children participated (154 with open-heart surgery; 265 without surgery). Global cognitive scores did not differ between the groups. Compared with the non-operated group, children who underwent surgery obtained lower scores in expressive language (p=0.03) and logical reasoning (p=0.05). When compared with test norms, the frequency of global cognitive scores >1 SDs below the expected mean was higher in the surgical group (25% vs 16% in the general population) (p=0.03). A higher-than-expected proportion of children in the non-operated group scored >2 SDs below the expected mean (7% vs 2%) (p=0.05). Being small for gestational age (SGA) significantly increased the risk of cognitive impairment in the surgical group, after adjustments for multiple covariates including maternal education, complexity of the CHD and operative-related variables (adjusted OR=5.9; 95% CI (1.7 to 20.1)). CONCLUSIONS Despite mean scores within the normative range, a high proportion of preschool children with CHD with or without surgery are at early cognitive risk. SGA is a strong predictor of the neurodevelopmental prognosis in CHD.
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Affiliation(s)
- Johanna Calderon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,Inserm, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Marion Willaime
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nathalie Lelong
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Damien Bonnet
- Centre de référence M3C, Necker, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Lucile Houyel
- Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, Paris, France
| | - Morgane Ballon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - François Goffinet
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,Maternité Port Royal, Paris, France
| | - Babak Khoshnood
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
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Khoshnood B, Lelong N, Houyel L, Bonnet D, Ballon M, Jouannic JM, Goffinet F. Impact of prenatal diagnosis on survival of newborns with four congenital heart defects: a prospective, population-based cohort study in France (the EPICARD Study). BMJ Open 2017; 7:e018285. [PMID: 29122798 PMCID: PMC5695380 DOI: 10.1136/bmjopen-2017-018285] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES (1) Assess the population-level probability of prenatal diagnosis and termination of pregnancy for fetal anomaly for four major congenital heart defects; (2) Examine, using population-based data, the relation between timing of (prenatal vs postnatal) diagnosis and risk of infant (ie, < 1 year) mortality for four major congenital heart defects (CHDs). DESIGN Population-based cohort (the EPIdémiologie des CARDiopathies congénitales) study. SETTING Greater Paris area (Paris and its surrounding suburbs). PATIENTS Three hundred and fifty-four cases of four major CHDs, including functionally univentricular heart (FUH, N=132), d-transposition of great arteries (d-TGA, N=85), tetralogy of Fallot (TOF, N=60) and coarctation of aorta (CoA, N=77). Statistical analysis included the Mantel-Haenszel method and a test of homogeneity of risk ratios. RESULTS Approximately 95% of FUH, more than two-thirds of d-TGA and TOF, and 40% of CoA were prenatally diagnosed. Overall, we did not find any statistically significant association between timing of (prenatal vs postnatal) diagnosis of CHD and risk of infant mortality (Mantel-Haenszel risk ratio 1.1, 95% CI 0.5 - 2.7); and the differences between the risk ratios of the association between prenatal diagnosis and infant mortality across the four CHDs was not statistically significant. CONCLUSION These results imply that at least in the settings where specialised services are readily available, survival may no longer be the most relevant outcome, or the best criterion, for evaluating the impact of prenatal diagnosis on the outcome of CHD. The beneficial effects of prenatal diagnosis may be better sought by looking at more 'subtle' or long-term neurodevelopmental outcomes.
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Affiliation(s)
- Babak Khoshnood
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | | | - Lucile Houyel
- Congenital heart defects surgery unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Damien Bonnet
- Complex Congenital Heart Defects Reference Center - M3C-Necker, Paris Descartes University, Paris, France
| | - Morgane Ballon
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jean-Marie Jouannic
- Centre Pluridisciplinaire de Diagnostic Prénatal, UPMC, Hôpital Trousseau, Paris, France
| | - François Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
- Maternité de Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Université Paris Descartes, Paris, France
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Nattel SN, Adrianzen L, Kessler EC, Andelfinger G, Dehaes M, Côté-Corriveau G, Trelles MP. Congenital Heart Disease and Neurodevelopment: Clinical Manifestations, Genetics, Mechanisms, and Implications. Can J Cardiol 2017; 33:1543-1555. [PMID: 29173597 DOI: 10.1016/j.cjca.2017.09.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022] Open
Abstract
Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental disorders (NDDs) and psychiatric conditions. These include cognitive, adaptive, motor, speech, behavioural, and executive functioning deficits, as well as autism spectrum disorder and psychiatric conditions. Structural and functional neuroimaging have demonstrated brain abnormalities in young children with CHD before undergoing surgical repair, likely as a result of an in utero developmental insult. Surgical factors do not seem to play a significant role in neurodevelopmental outcomes. Specific genetic abnormalities, particularly copy number variants, have been increasingly implicated in both CHD and NDDs. Variations in genes involved in apolipoprotein E (APOE) production, the Wnt signalling pathway, and histone modification, as well as in the 1q21.1, 16p13.1-11, and 8p23.1 genetic loci, have been associated with CHD and NDDs and are important targets for future research. Understanding these associations is important for risk stratification, disease classification, improved screening, and pharmacologic management of individuals with CHD.
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Affiliation(s)
- Sarah N Nattel
- Department of Psychiatry, Albert Einstein College of Medicine and Seaver Autism Center at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura Adrianzen
- Department of Psychiatry, Seaver Autism Center at Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Gregor Andelfinger
- Department of Pediatrics, University of Montreal and Ste-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - Mathieu Dehaes
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal and Ste-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - Gabriel Côté-Corriveau
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal and Ste-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - M Pilar Trelles
- Department of Psychiatry, Seaver Autism Center at Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Baker-Smith CM, Carlson K, Ettedgui J, Tsuda T, Jayakumar KA, Park M, Tede N, Uzark K, Fleishman C, Connuck D, Likes M, Penny DJ. Development of quality metrics for ambulatory pediatric cardiology: Transposition of the great arteries after arterial switch operation. CONGENIT HEART DIS 2017; 13:52-58. [PMID: 28971577 DOI: 10.1111/chd.12540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/13/2017] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop quality metrics (QMs) for the ambulatory care of patients with transposition of the great arteries following arterial switch operation (TGA/ASO). DESIGN Under the auspices of the American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Steering committee, the TGA/ASO team generated candidate QMs related to TGA/ASO ambulatory care. Candidate QMs were submitted to the ACPC Steering Committee and were reviewed for validity and feasibility using individual expert panel member scoring according to the RAND-UCLA methodology. QMs were then made available for review by the entire ACC ACPC during an "open comment period." Final approval of each QM was provided by a vote of the ACC ACPC Council. PATIENTS Patients with TGA who had undergone an ASO were included. Patients with complex transposition were excluded. RESULTS Twelve candidate QMs were generated. Seven metrics passed the RAND-UCLA process. Four passed the "open comment period" and were ultimately approved by the Council. These included: (1) at least 1 echocardiogram performed during the first year of life reporting on the function, aortic dimension, degree of neoaortic valve insufficiency, the patency of the systemic and pulmonary outflows, the patency of the branch pulmonary arteries and coronary arteries, (2) neurodevelopmental (ND) assessment after ASO; (3) lipid profile by age 11 years; and (4) documentation of a transition of care plan to an adult congenital heart disease (CHD) provider by 18 years of age. CONCLUSIONS Application of the RAND-UCLA methodology and linkage of this methodology to the ACPC approval process led to successful generation of 4 QMs relevant to the care of TGA/ASO pediatric patients in the ambulatory setting. These metrics have now been incorporated into the ACPC Quality Network providing guidance for the care of TGA/ASO patients across 30 CHD centers.
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Affiliation(s)
- Carissa M Baker-Smith
- Department of Pediatrics/Division of Pediatric Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karina Carlson
- Department of Pediatrics/Division of Pediatric Cardiology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jose Ettedgui
- Department of Pediatrics/Division of Pediatric Cardiology, University of Florida, Jacksonville, Florida, USA
| | - Takeshi Tsuda
- Department of Pediatrics/Division of Pediatric Cardiology, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - K Anitha Jayakumar
- Department of Pediatrics/Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew Park
- Pediatrix Medical Group - Northwest Children's Heart Care, Tacoma, Washington, USA
| | - Nikola Tede
- California Pacific Medical Center, San Francisco, California, USA
| | - Karen Uzark
- Department of Pediatrics/Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, Missouri, USA
| | - Craig Fleishman
- Department of Pediatrics/Division of Pediatric Cardiology, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - David Connuck
- Janet Weis Children's Hospital, Danville, Pennsylvania, USA
| | - Maggie Likes
- Department of Pediatrics/Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Daniel J Penny
- Department of Pediatrics/Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Abstract
RESEARCH QUESTION Is there an association between regular exercise, defined as a structured program of increased physical activity at least 1 month in duration, and improvements in measures of executive functions compared with children who engage in their normal daily activities? CONTEXT The association between increased physical activity and changes in performance on tasks of executive functions have not been well elucidated in children. Executive functioning is important to intellectual development and academic success in children, and inexpensive, nonpharmacological methods for the treatment of executive dysfunction represent an attractive interventional target. OBJECTIVE To estimate the effect of a structured regular exercise program on neuropsychological domains of executive function in children ages 7 to 12. DATA SOURCES We performed a systematic review of English and non-English articles using Cochrane Library, EBSCO CINAHL, Ovid MEDLINE, PSYCInfo, Pubmed, and Web of Science, including all years allowed by each individual search engine. The search string used was "(exercise OR phys*) AND (cognit* OR executive) AND (child* OR preadolesc*)." The authors of the studies selected for review were contacted for any unpublished data. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, which enrolled children between the ages of 7 and 12, with randomization to either normal activity or a structured physical activity intervention consisting of scheduled aerobic exercise, at least once per week, for a period of at least 1 month. Eligible studies must have included a neuropsychological battery of tests that measured at least 1 executive function both before and after the intervention was completed. STUDY APPRAISAL Two independent reviewers examined the screened studies in detail for potential inclusion. The results of the individual examinations were compared; if any discrepancies were present, a third party analyzed the study to determine if it should be included in the meta-analysis. RESULTS A total of 18 studies were identified by abstract as candidates for inclusion. From these 18 studies, 8 were independently selected by 2 authors for inclusion in the final analysis; there were no selection discrepancies between authors with regard to the studies to be included. In all, 770 subjects were included, 339 in the control group and 431 in the intervention group. All 8 studies contained a measure of inhibitory control; no other domain of executive function was measured frequently enough to perform meta-analysis, so only measures of inhibitory control were pooled and analyzed. A Cohen d effect size was calculated for each measure using the method of Morris for controlled pre-post control measurement studies. The studies were then combined in a random effects model using Comprehensive Meta Analysis software (Biostat, Englewood, NJ) for Windows (Microsoft, Redmond, WA). All studies showed a positive effect of regular exercise with improvements in measures of inhibitory control, but none were statistically significant for this measure. When pooled, the model revealed a combined Cohen d effect size of 0.2 (95% confidence interval, 0.03-0.37; P=0.021), indicating a small improvement of inhibitory control with long-term physical activity. Heterogeneity was very low (I=0). LIMITATIONS Many studies used different neuropsychological tests to assess inhibitory control, which may have introduced unforeseen confounders. Other domains of executive functions were not measured frequently enough to perform meta-analysis. Despite attempts to gather unpublished data, positive results were observed in all of the included studies, raising the possibility of publication bias. CONCLUSIONS AND IMPLICATIONS Increased regular physical activity is associated with a small and measurable, improvement in neuropsychological tests of executive functions, specifically inhibitory control. Executive functions play an important role in complex behavior, and may contribute to academic and career achievement as well as success in social interaction. This finding provides support for the important interaction between exercise and cognitive functioning.
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Cassidy AR, Ilardi D, Bowen SR, Hampton LE, Heinrich KP, Loman MM, Sanz JH, Wolfe KR. Congenital heart disease: A primer for the pediatric neuropsychologist. Child Neuropsychol 2017; 24:859-902. [DOI: 10.1080/09297049.2017.1373758] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Adam R. Cassidy
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Susan R. Bowen
- Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lyla E. Hampton
- Department of Child & Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Michelle M. Loman
- Departments of Neurology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacqueline H. Sanz
- Division of Neuropsychology, Children’s National Health System, Departments of Psychiatry and Behavioral Sciences & Pediatrics, George Washington University School of Medicine, , Washington, DC, USA
| | - Kelly R. Wolfe
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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Claessens NHP, Kelly CJ, Counsell SJ, Benders MJNL. Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease. Dev Med Child Neurol 2017; 59:894-902. [PMID: 28542743 DOI: 10.1111/dmcn.13461] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
This review integrates data on brain dysmaturation and acquired brain injury using fetal and neonatal magnetic resonance imaging (MRI), including the contribution of cardiovascular physiology to differences in brain development, and the relationship between brain abnormalities and subsequent neurological impairments in infants with congenital heart disease (CHD). The antenatal and neonatal period are critical for optimal brain development; the developing brain is particularly vulnerable to haemodynamic disturbances during this time. Altered cerebral perfusion and decreased cerebral oxygen delivery in the antenatal period can affect functional and structural brain development, while postnatal haemodynamic fluctuations may cause additional injury. In critical CHD, brain dysmaturation and acquired brain injury result from a combination of underlying cardiovascular pathology and surgery performed in the neonatal period. MRI findings in infants with CHD can be used to evaluate potential clinical risk factors for brain abnormalities, and aid prediction of functional outcomes at an early stage. In addition, information on timing of brain dysmaturation and acquired brain injury in CHD has the potential to be used when developing strategies to optimize neurodevelopment.
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Affiliation(s)
- Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christopher J Kelly
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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