Neurocognitive Impairment in Children with Congenital Heart Disease

Background: Congenital heart diseases (CHD) represent the most common type of congenital abnormalities. Thanks to recent improvements in medical and surgical treatment, more than 90% of children with critical heart defects achieve the adult age. Conversely, survirvors are at risk for neurodevelopmental morbidity.

Objective: The aim of this study was to evaluate the presence of cognitive dysfunction, behavioural problems and difficulties in social interaction in children with CHD who underwent heart surgery in cardiopulmonary bypass (CBP).

Methods: Children aged 6-13 years with a diagnosis of CHD and a previous CBP surgery were included. We used the Wechsler Intelligence Scale for Children - Fourth edition (WISC IV) to evaluate general intelligence, the Conner’s Parent Rating Scale - Revised (CPRS-R) and the Child Behaviour Checklist (CBCL) to identify problem behavior in children, and the Adaptive Behaviour Assessment System II (ABAS II) to evaluate adaptive skills.

Results: A total of 17 children (7 males, median age 10+2.18) were enrolled. IQ scores were consistently lower in the studied group than in the standard population (90.9+18.3 vs 100+15; p=.03). Perceptual reasoning index (99.4+18.3) resulted to be higher than verbal comprehension (90.1+15.7; p=.02), working memory (89.9+17.7; p=.01) and processing speed (90.2+18.7; p=.03). The ADHD index evaluated by the CPRS-R was significantly higher in our patients than in the standard population (64.2+4.2 vs 50+10; p=.001). Twelve families out of 17 (70%) filled the CBCL and 5/12 (42%) reported their children having behavioural issues. According to the ABAS II a significant impairment in adaptive skills emerged in these children in comparison to the standard population (86+30 vs 100+15; p=.008).

Conclusion: Children with CHD who underwent CBP surgery presented significant cognitive impairment, behavioural problems and poor adaptive skills. Screening and evaluation of neurodevelopmental delay, along with regular follow-up, are essential to guide appropriate interventions to optimize their development.