Growth and IQ in Children With Congenital Heart Disease

Abstract

Research Article| May 01 2019 Growth and IQ in Children With Congenital Heart Disease AAP Grand Rounds (2019) 41 (5): 57. https://doi.org/10.1542/gr.41-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Growth and IQ in Children With Congenital Heart Disease. AAP Grand Rounds May 2019; 41 (5): 57. https://doi.org/10.1542/gr.41-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: congenital heart disease Source: Heye KN, Rousson V, Knirsch W, et al. Growth and intellectual abilities of six-year-old children with congenital heart disease. J Pediatr. 2019; 204: 24.e10– 30.e10; doi: https://doi.org/10.1016/j.jpeds.2018.08.060Google Scholar Investigators from University Children’s Hospital, Zurich, Switzerland, and University Hospital of Lausanne, Switzerland, conducted a prospective cohort study to assess growth and IQ in children with congenital heart disease (CHD) who underwent cardiopulmonary bypass (CPB) surgery in infancy. Study participants were patients undergoing CPB surgery in the first year of life at University Children’s Hospital Zurich. Children with a recognizable genetic or phenotypic syndrome and those with a birth weight <2,000 g were excluded. Data on the type of CHD and clinical course during and after CPB surgery were collected. The birth records of study patients were reviewed and data on weight, length, and head circumference (HC) abstracted. Anthropometric measurements were repeated just prior to surgery and at 1, 4, and 6 years of age. IQ testing was performed when study children were 6 years old by using the Wechsler Preschool and Primary Scale of Intelligence III or, in children with developmental and/or speech and language delay, the Snijders Oomen nonverbal intelligence tests. The socioeconomic status (SES) of study patients was classified based on maternal education level and paternal occupation. The primary outcomes were weight, height, HC, and IQ at 6 years, and secondary outcomes included growth trajectories. Growth parameters of study participants were standardized and compared to Swiss growth chart values by using Wilcoxon signedrank tests. Regression analyses, including multiple clinical characteristics and SES, were used to identify statistical associations with IQ at 6 years of age. Data were analyzed in 143 children. The most common CHD was transposition of the great arteries (occurring in 29% of study patients), 71% had a cyanotic heart defect, and 20% had univentricular physiology. Weight and length were normal at birth, but HC was significantly lower than expected (median 33rd percentile; P=.03). All growth parameters, especially weight, decreased compared to expected values just prior to surgery and improved after surgery, particularly within the first year of life. At 6 years of age, height was normal, but weight (P<.01) and HC (P<.001) remained significantly lower than expected. Median IQ in study patients was 95 (range, 50–135) at 6 years of age; 7 patients (5%) had a measured IQ <70. In the multivariate analysis, lower SES, smaller HC at birth, older age at first CPB surgery, and longer ICU stays postoperatively were independently associated with lower IQ at 6 years of age. The authors conclude that smaller HC at birth and lower SES, as well as potentially modifiable clinical factors, are associated with lower IQ at 6 years of age in children with CHD who undergo CPB surgery in infancy. Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Children with CHD often require... You do not currently have access to this content.