Motor dysfunction and behavioural problems frequently coexist with congenital heart disease in school-age children.

AIM: Patients with congenital heart disease are at risk of neurodevelopmental deficits. Impairments in motor and behavioural function occur frequently, but no information is available concerning the coexistence of deficits in these two developmental domains. This study explored the occurrence of motor and behavioural deficits and their coexistence in children with surgically corrected congenital heart disease. METHODS: Outcome was assessed in 95 children with congenital heart disease who had undergone cardiopulmonary bypass surgery. Their mean age was 9.6 years (SD 2.5). Motor function was assessed with the Zurich Neuromotor Assessment and behaviour with the Strength and Difficulties Questionnaire. RESULTS: Children with congenital heart disease performed poorer in all motor domains compared with the reference population (all p ≤ 0.001). Behaviour was affected in the domains 'emotional symptoms' and 'hyperactivity/inattention' (both p < 0.01), and 54% of the children with motor abnormalities showed behavioural deficits. Children with coexistent abnormalities in behaviour and motor function had higher rates of remedial school services and therapeutic support. CONCLUSION: Children with congenital heart disease are at risk of long-term motor and behavioural problems, and there is a high rate of coexistence of problems in both domains. Early and longitudinal assessment of all developmental domains is necessary to provide adequate early support.

Abnormal interhemispheric connectivity in neonates with D-transposition of the great arteries undergoing cardiopulmonary bypass surgery.

BACKGROUND AND PURPOSE: Neonates with severe CHD require CPB within the first days of life. White matter injury can occur before surgery, and this may impair the long-term neurodevelopmental and psychosocial outcome. The purpose of this study was to assess the microstructural development of the CC in infants with CHD before and after CPB for transposition of the great arteries. MATERIALS AND METHODS: Fifteen patients with CHD and 11 age-matched HC were recruited. We separately quantified the parallel (E1) and perpendicular (E23) diffusions, the ADC, and FA of the genu of the CC and splenium of the CC before and after surgery. RESULTS: In presurgical measures of the genu of the CC, higher E23 (P = .018), higher ADC (P = .026), and lower FA (P = .033) values were measured compared with those in HC. In the postsurgery scans, the genu of the CC had higher E23 (P = .013), higher ADC (P = .012), and lower FA (P = .033) values compared with those in HC. There was no significant difference in any DTI indices between the pre- and postsurgical groups. CONCLUSIONS: We report abnormal microstructural development in the genu of the CC of infants with d-TGA before and after CPB. High E23, high ADC, and low FA values in the genu of the CC may be explained by abnormal axonal pruning, thinner myelin sheaths, smaller axonal diameters, or more oligodendrocytes. It appears that the genu of the CC is more vulnerable than the splenium of the CC in patients with CHD and may serve as a biomarker to identify infants at highest risk for adverse neurodevelopmental outcome.

Residual gastric contents volume does not differ following 4 or 6 h fasting after a light breakfast - a magnetic resonance imaging investigation in healthy non-anaesthetised school-age children.

BACKGROUND: While American Society of Anesthesiologists and European Society of Anaesthesiology guidelines recommend 6 h pre-anaesthetic fasting for food and non-clear fluids in children, some institutions allow shorter fasting times of 4 h. Aim of this pilot study was to compare weight-indexed residual gastric contents volumes (GCV(w)) after 4 vs. 6 h after a light breakfast, using magnetic resonance imaging (MRI) in healthy volunteer children not scheduled for anaesthesia. METHODS: Four vs. 6 h (F(4) /F(6)) of food fasting were simulated in a crossover study. After overnight fasting (baseline), each child ingested a light breakfast (cereal flakes, milk products) on two separate days. Additional clear fluid (7 ml/kg raspberry syrup) was given either after 2 (F(4) ) or 4 h (F(6) ), followed by half-hourly MRI acquisition for 2 h. MRI was obtained on a 1.5 Tesla scanner as 5 mm axial images (FIESTA) and volumes were traced manually by one blinded observer. Data are given as median (range) or mean ± standard deviation. RESULTS: Eighteen healthy volunteers aged 9.0 (6.8-12.2) years participated. GCV(w) for F(4) and F(6) at baseline was 0.50 ± 0.27 and 0.76 ± 0.48 ml/kg (P = 0.07), respectively, GCV(w) after 4 and 6 h was 0.72 ± 0.85 and 0.47 ± 0.25 ml/kg (P = 0.88). T(1/2) after syrup intake was 30.8 ± 12.2 and 28.3 ± 5.7 min (P = 0.47) for F(4) and F(6) , respectively. CONCLUSION: Residual gastric contents volumes at a hypothetical anaesthesia start were similar for 4 and 6 h food fasting in healthy volunteer school-age children.

Gastric emptying after overnight fasting and clear fluid intake: a prospective investigation using serial magnetic resonance imaging in healthy children.

BACKGROUND: Current guidelines recommend preoperative fasting of 2 h for clear fluids, which is often exceeded in routine clinical practice. Existing data on residual gastric volumes in children do not consider fluid intake within <2 h and rely on the aspiration of gastric contents via a gastric tube. This study evaluated the emptying of clear fluids from the stomach using magnetic resonance imaging (MRI). METHODS: Healthy volunteers aged 6-14 years were asked to fast overnight. MRI scans to assess gastric volumes were obtained before and immediately after drinking 7 ml kg(-1) of diluted raspberry syrup and then every 30 min up to 120 min. Volumes were determined by a blinded investigator and indexed gastric fluid/air volumes (GFV(w)/GAV(w)) and half-life (t(1/2)) of GFV(w) course after clear fluid intake were calculated. RESULTS: Sixteen children, median age 9.2 (range 6.4-12.8) years, were investigated. Median (range) GFV(w) was 0.62 (0.15-0.97) ml kg(-1) before and 6.68 (4.77-7.78) ml kg(-1) immediately after fluid intake, and 2.92 (0.43-5.04), 1.27 (0.28-3.62), 0.42 (0.07-2.49), and 0.32 (0.04-1.13) ml kg(-1) 30, 60, 90, and 120 min thereafter. Median GFV(w) declined exponentially (t(1/2)=26.1 min). Median individual t(1/2) was 23.6 (range 17.9-47.8) min. GAV(w) showed considerable intra- and inter-individual variation. CONCLUSIONS: In healthy school children, gastric emptying after ingestion of clear fluid occurs with a median half-life time of <30 min but with considerable inter-individual variation.