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Population-based study of cognitive outcomes in congenital heart defects
  1. Johanna Calderon1,2,
  2. Marion Willaime1,
  3. Nathalie Lelong1,
  4. Damien Bonnet3,
  5. Lucile Houyel4,
  6. Morgane Ballon1,
  7. François Goffinet1,5,
  8. Babak Khoshnood1
  9. on behalf of the EPICARD study group
  1. 1Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Inserm, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
  3. 3Centre de référence M3C, Necker, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
  4. 4Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, Paris, France
  5. 5Maternité Port Royal, Paris, France
  1. Correspondence to Dr Johanna Calderon, Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; johanna.calderon{at}childrens.harvard.edu

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.

  • congenital heart disease
  • cognitive outcomes
  • small for gestational age
  • open-heart surgery
  • minor CHD
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Footnotes

  • Contributors JC made substantial contributions to the study design, analysed the data, drafted the manuscript and revised it critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. MW made substantial contributions to acquisition and analyses of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. NL made substantial contributions to acquisition and analyses of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. DB made substantial contributions to the study design and interpretation of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. LH made substantial contributions to the study design and interpretation of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. MB made substantial contributions to acquisition and analyses of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. FG made substantial contributions to the study design and interpretation of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. BK made substantial contributions to the study design and interpretation of the data, revised the manuscript critically for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work. Persons cited in the acknowledgements section have given written permission to be acknowledged in the manuscript.

  • Funding This work was supported by three grants from the French Ministry of Health (PHRC 2004, 2008 and 2011). Additional funding was provided by the AREMCAR (Association pour la Recherche et l’Etude des Maladies Cardiovasculaires) association. The funding sources had no role in the study design, data collection, data interpretation or the writing of the manuscript.

  • Patient consent Obtained.

  • Ethics approval Ethics Board Necker Children's Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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