Psychomotor development of children with congenital heart disease

ABSTRACT

Children with congenital heart disease [CHD] have an increased risk for neurocognitive deficits. As the mortality of neonatal and infant surgery for CHD continues to decrease, attention is now focused on long- term sequelae, especially later cognitive and neurological function, in survivors. The aim of this work is the early assessment of the psychomotor and cognitive development in children with CHD before two years of age and to evaluate the difference between cyanotic and a cyanotic CHD regarding this development. This could help in early management to minimize neurological injury and improve the intellectual function and academic achievement for such patients in the future. Thirty-eight children with CHD [25 males and 13 females] below two years of age were studied. Twelve of them were cyanotic [31.5%] and twenty-six were a cyanotic [68.5%] CHD. Twenty children of matched age and sex were included in the study as controls. All patients were neurologically free on clinical examination. Anthropometric measurements of patients and controls were recorded including weight, recumbent length, head circumference, mid-arm circumference and the body mass index. The anthropometric percentiles were recorded as well including head circumference for age, recumbent length for age, weight for age, and weight for recumbent length percentiles. The Griffiths developmental scale were used to assess the cognitive and psychomotor developmental status of the children. They covered locomotor skills, personal social skills, hearing speech, eye-hand coordination, and cognitive performance. Total intellectual quotients [IQ %] were calculated. EEG was recorded and Echocardiography was performed for confirming the diagnosis of the CHD, measuring blood flow velocities and the pulmonary pressure. Twelve out of thirty-eight children with CHD [12/38] were diagnosed as cyanotic CHD and included TOF, D-TGA, and DORV as well as [26/38] of patients were diagnosed as a cyanotic CHD and included VSD, ASD, and pulmonary stenosis. The anthropometric measurements and percentiles were significantly lower in patients than controls with no significant differences between cyanotic and cyanotic groups. The IQ% in the studied patients ranged from 68-105% [mean 83.9 +/- 10.6] with no significant difference between cyanotic CHD [mean 82.3 +/- 15] and a cyanotic CHD group [mean 83.7 +/- 10.5] and all were considered sub average [IQ% below 90%]. Hearing speech and eye-hand coordination were the most affected parameter in the two groups of patients. There was a significant positive correlation [r= 0.439, p<0.006] between 16% and head circumference for age percentile. No relation was detected between IQ % and the other anthropometric percentiles or measurements. There was a significant negative correlation [r=-0.826, p<0.001] between IQ% and degree of pulmonary stenosis [pulmonary blood flow velocity cm/sec] in patients with valvular pulmonary stenosis and TOF, a significant positive correlation [r= 0.722, p<0.0008] between IQ % and aortic blood flow velocity [cm/sec] in patients with cyanotic CHD, a significant negative correlation [r =-0.596, p<0.0001] between IQ% and systolic pulmonary pressure in patients with cyanotic CHD. EEG changes were detected in 68% of patients. There was a significant negative correlation [r = - 0.826, p<0.001] between the severity of EEG changes and 14% in the studied patients