Effect Of Congenital Heart Disease Research Articles

A study of the effect of congenital heart disease on somatic growth by comparing identical twins anthropometric profiles

Abstract Purpose This study seeks to evaluate the impact of congenital heart disease (CHD) on somatic growth while controlling for the influence of other growth-related factors. Method A retrospective cohort study was conducted on identical twins, with one twin having CHD (CHD group) and the other without CHD (non-CHD group). Anthropometric measures, including weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and head-circumference (HCZ) z-scores based on WHO growth standards, were employed, and growth failure was defined by z-scores below -2. Predictive factors of growth failure included gestational age, cyanosis, pulmonary arterial hypertension (PAH), heart failure, and ventricular physiology. Results Anthropometric indices from 41 pairs of twins were analyzed. The CHD group exhibited a significant decline in all growth parameters from the age of 1 year (p < .001). Although the growth disparity between twins lessened over time, the CHD group continued to lag behind the non-CHD group at follow-up (p < .05). Moreover, a higher proportion of the CHD group experienced malnutrition (46.3%) compared to the non-CHD group (7.5%, RR 1.724, 95% CI 1.280 to 2.232, p < .001, at the age of 1). Among disease characteristics, children with cyanosis, PAH, and heart failure displayed a significant decrease in growth z-scores compared to their unaffected twin siblings. However, statistical significance was observed only between weight-for-height z-scores and cyanosis (cyanosis 1.8±1.7 vs acyanosis -0.8±1.4, p = .032). Conclusion Children with CHD exhibited compromised growth compared to their non-affected twin siblings, with no complete catch-up growth observed during the observation period. The heightened prevalence of growth failure in the CHD group emphasizes the increased risk of malnutrition in children with CHD.

The Effects of Congenital Heart Disease on the Development of Autism Spectrum Disorder in Pediatric Patients

It is a well-known fact that congenital heart disease (CHD) can cause life-long health complications, especially if it impairs other bodily functions early in life. One of these complications is the risk of developing a serious neurodevelopmental disorder known as autism spectrum disorder (AuSD). With some case studies identifying the linkage of CHD and AuSD, it has been successfully established that being diagnosed with CHD does increase a child’s chances of developing AuSD later in life. There is not a simple answer for why this occurs. However, there are several factors that can contribute to why CHD increases the risk of developing autism. Some possible explanations may include synthetic factors such as the alteration of blood flow in genetic pathways due to early cardiac surgery. These explanations can also include uncontrollable factors such as demographics, maternal conditions, and viral infections, all of which are just as likely as synthetic factors. This research, based on case studies conducted recently, further reinforces the conclusion that the diagnosis of certain lesions of CHD results in an elevated risk of developing AuSD.

Behavioral and Emotional Outcomes in Children with Congenital Heart Disease: Effects of Disease Severity, Family Life Stress, Disease-Related Chronic Stress, and Psychosocial Adaptation

To evaluate whether effects of congenital heart disease (CHD) severity and family life stress on behavioral and emotional functioning are mediated by disease-related chronic stress and psychosocial adaptation. A cross-sectional analysis of the Pediatric Cardiac Quality of Life Inventory Testing Study was performed. Relationships between CHD severity (comprising 3 groups: mild heart disease, moderate biventricular disease, and single ventricle) and family life stress, on patient- and parent disease-related chronic stress, psychosocial adaptation, and behavioral-emotional outcomes were assessed using structural equation modeling. Patient and parent models were reported separately. There were 981 patient-parent dyads: 22% had mild heart disease, 63% biventricular, and 15% single ventricle; 19% of families reported moderate to major family life stress. Path models revealed that CHD severity and family life stress were mediated by disease-related chronic stress and psychosocial adaptation factors (R2=0.18-0.24 for patient outcomes and R2=0.33-0.34 for parent outcomes, P<.001, respectively). The effects of greater CHD severity and family life stress on behavioral-emotional outcomes were mediated by worse disease-related chronic stress and psychosocial adaptation factors. Both disease-related chronic stress and psychosocial adaptation factors may be targets for interventions to improve behavioral and emotional outcomes.

TAF1 bromodomain inhibition as a candidate epigenetic driver of congenital heart disease

Heart formation requires transcriptional regulators that underlie congenital anomalies and the fetal gene program activated during heart failure. Attributing the effects of congenital heart disease (CHD) missense variants to disruption of specific protein domains allows for a mechanistic understanding of CHDs and improved diagnostics. A combined chemical and genetic approach was employed to identify novel CHD drivers, consisting of chemical screening during pluripotent stem cell (PSC) differentiation, gene expression analyses of native tissues and primary cell culture models, and the in vitro study of damaging missense variants from CHD patients. An epigenetic inhibitor of the TATA-Box Binding Protein Associated Factor 1 (TAF1) bromodomain was uncovered in an unbiased chemical screen for activators of atrial and ventricular fetal myosins in differentiating PSCs, leading to the development of a high affinity inhibitor (5.1 nM) of the TAF1 bromodomain, a component of the TFIID complex. TAF1 bromodomain inhibitors were tested for their effects on stem cell viability and cardiomyocyte differentiation, implicating a role for TAF1 in cardiogenesis. Damaging TAF1 missense variants from CHD patients were studied by mutational analysis of the TAF1 bromodomain, demonstrating a repressive role of TAF1 that can be abrogated by the introduction of damaging bromodomain variants or chemical TAF1 bromodomain inhibition. These results indicate that targeting the TAF1/TFIID complex with chemical compounds modulates cardiac transcription and identify an epigenetically-driven CHD mechanism due to damaging variants within the TAF1 bromodomain.

Abstract 9983: The Effect of Congenital Heart Disease on Employment, Neuropsychological Outcomes, and Quality of Life in Adults With Down Syndrome

Introduction: Individuals born with congenital heart disease (CHD) and people with Down syndrome (DS) are distinct populations now living well into adulthood. These groups share risks of reduced employment, neuropsychological impairment, and poor quality of life (QOL). CHD occurs in 40-60% of people with DS; is it unknown whether CHD mediates these outcomes among adults with DS. Hypothesis: There are lower employment rates in adults with both DS and CHD. Methods: This was a cross-sectional survey of adults ages 18-45 years with DS and their guardian. Study advertisements were sent to the NIH Down Syndrome Registry, regional DS groups, and cardiology clinics. The study survey included self or proxy-reported medical history, employment and volunteer experience, quality of life (WHO-QOL-Disabilities module), mental health problems (self-report plus Glasgow Depression Scale), and caregiver burden (Zarit Burden Interview). Outcomes were compared between groups: DS+CHD and DS-CHD. Results: 287 participants completed the study, out of roughly 1100 eligible subjects recruited. 36% (n=104) reported having CHD. Most CHD types were atrioventricular canal or atrial/ventricular septal defect, and 56% reported cardiac surgery in the first year of life. There were no significant differences in subject age, sex, or trisomy 21 type between groups. There were similar rates of paid employment in those with and without CHD (54% vs. 50% respectively, p= 0.50). DS+CHD subjects reported significantly more volunteer activity (32% vs. 19%, p&lt; 0.01). Overall cohort history of stroke was 3%, seizure 12%, and mental health problems 69%. There were significantly higher rates of stroke and seizure in DS+CHD subjects (p&lt; 0.01 for both), though no difference in mental health problems (p=0.67). Self-reported mean QOL score was 66.6± 12.1 (scale 1-100 with 100 indicating best quality), with no significant difference between groups (p= 0.52). Caregiver burden was significantly greater in DS+CHD (p= 0.03). Conclusions: Having CHD is not associated with reduced employment in adults with DS, despite higher prevalence of stroke and seizures. Volunteer participation is more common in those with CHD. Mental health problems and reduced QOL are prevalent in adults with DS regardless of CHD.

Prevalence of attention deficit/hyperactivity disorder (ADHD) in congenital heart diseases (CHD), a systematic review and meta-analysis

Abstract Introduction Neuropsychiatric disorders are well-established in patients with congenital heart defects (CHD); moreover, patients with CHD have higher three to four times risk for inattention and hyperactivity. Several published studies have investigated the prevalence of attention deficit/hyperactivity disorder (ADHD) among patients with CHD, thus we conducted our meta-analysis in an attempt to further investigate the role of CHD in increasing the incidence of ADHD. Methods Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of congenital heart disease on the incidence or progression of ADHD. Pooled mean difference (MD) and their 95% confidence intervals (CI) were calculated using inverse variance and fixed effect models Results We identified eight studies with 120187 patients with a mean age of 15.8 years. Patients with CHD compared to healthy population have statistically significant higher scores in ADHD inattention subscale, ADHD hyperactivity-impulsivity subscale, ADHD combined scale (Fig. 1) with MD of 0.25 [95% CI 0.13, 0.37, p&amp;lt;0.0001], 0.16 [95% CI 0.04, 0.28, p=0.008], 0.23 [95% CI 0.11, 0.35, p=0.0002], respectively. Furthermore, ADHD index T score (Fig. 2) for both self-reported and informant report showed a statistically significant increase in CHD with MD of 0.42 [95% CI 0.26, 0.58, p&amp;lt;0.00001] and 0.86 [95% CI 0.52, 1.19, p&amp;lt;0.00001]. Conclusion CHD showed an associated increased risk for the development of ADHD which was confirmed with several ADHD scales. Funding Acknowledgement Type of funding sources: None.

Congenital Heart Disease and Neurodevelopmental Outcomes in Infants and Adolescents

Abstract: Patients with complicated congenital heart disease are at risk of neurodevelopmental disability. This study aimed to study the correlation between brain development and congenital heart disease in infants. Studies have shown that brain maturation is delayed, and injury may be caused in the white matter or brain volume after the interventions like surgery for congenital heart disease. Secondary research was conducted to find the results of the effects of congenital heart disease on brain development. It was found that white matter has more injury than grey matter. The total brain volume is lower than in control patients. Amongst six different types of congenital heart disease (TOF, DORV, TGA, AoOb, HLHS, HRHS) studied Tetralogy of Fallot showed the most reduced brain volume compared to others. Adolescents with cyanotic heart disease lost more brain volume than those without, particularly in the white matter. In conclusion, it was found that patients with congenital heart disease have smaller brain volumes, smaller cerebellar volumes, and injury in the white matter

Effect of congenital heart disease on the recurrence of cough variant asthma in children

BackgroundThe research into the recurrence of cough variant asthma (CVA) in congenital heart disease (CHD) are few in number. The purpose of this study is to investigate the effect of CHD on the risk of the recurrence of CVA.MethodsThis study was a retrospective cohort study of 489 children with CVA aged between one and 14 years, of whom 67 had CHD complicated with CVA and 134 had CVA without CHD at a ratio of 1:2 according to age, sex and index year. The adjusted hazard ratio (aHR) of CVA recurrence in both the CHD cohort and the non-CHD cohort was determined by multivariate analysis using the Cox proportional hazard regression model.ResultsAdjusting for CHD classification, Mycoplasma pneumonia (MP) infection and immunoglobulin E (IgE) sensitization, the recurrence hazard of CVA in the complex congenital heart disease (CCHD) group (aHR = 3.281; 95% CI 1.648–6.530; P < 0.01) was significantly higher than that in the simple congenital heart disease group (aHR = 2.555; 95% CI 1.739–3.752; P < 0.01). Further, children with IgE sensitization (aHR = 2.172; 95% CI 1.482–3.184; P < 0.01) had a higher recurrence hazard of CVA than those without IgE sensitization, and children with MP infection (aHR = 1.777; 95% CI 1.188–2.657; P < 0.01) had a higher recurrence hazard of CVA than those without the MP infection.ConclusionThe hazard of recurrent CVA is higher in children with CHD, especially in the CCHD children. In addition, those children with IgE sensitization or a MP infection had an increased hazard of recurrent CVA.

Prevalence and Outcomes of Congenital Heart Disease in Very Low Birth Weight Preterm Infants: An Observational Study From the Brazilian Neonatal Network Database.

To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants. Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey. Twenty public tertiary-care university hospitals. A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017. None. The prevalence of congenital heart disease was 2.45% (95% CI, 2.20-2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11-2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73-2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43-0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21-0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55-0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22-2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03-2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13-2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41-4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used. The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.

Effectiveness of Teaching Sessions on Anxiety Level among Mothers Caring Children with Congenital Heart Disease

Congenital heart disease is a stressful and anxiety overwhelming experience for parents and their children, therefore nurses are pivotal in providing a comprehensive and evidence based strategies to reduce anxiety among parents and enhance their children' wellbeing. Aim: To evaluate the effectiveness of teaching sessions on anxiety level among mothers of children with congenital heart disease. Study design: A quasi-experimental design was used. Setting: The study was conducted in paediatric cardiology department at Mansoura University Children Hospital affiliated to Mansoura University. Sample: A purposive sample of forty mothers having children from 3 months to 6 years with congenital heart disease were participated in this study. Tools of data collection: Three tools were used; first: by Interview Questionnaire to gather data about characteristic of the study subjects, mothers' knowledge regarding congenital heart disease. Second: Mothers' reported practice sheet was designed by the researchers to assess mothers' reported practice regarding congenital heart disease. Third: Taylor’s Manifest Anxiety Scale was used to assess the anxiety level of the studied mothers. Results: There was a highly statistical significant difference between the studied mothers' total mean score of knowledge and reported practice with positive correlation regarding congenital heart disease at pre and post teaching sessions. Also, there was highly significant negative correlation among mothers' knowledge, practice and anxiety level. Conclusion: the implementation of teaching sessions for the mothers of children with congenital heart disease had reduced their anxiety level. Furthermore, teaching sessions had improved mothers' total mean score of knowledge and reported practices about caring of children with congenital heart disease. Recommendations: The study recommended establishing programs, as mothers' support groups, to assist them overcome the adverse psychological effects of congenital heart disease among their children.

Congenital Heart Disease is a Risk Factor for the Success of Catheter Ablation in Children < 15 kg

Catheter ablation has been successful for small children (≤15 kg) in selected cases, however there is a paucity of data comparing the effect of congenital heart disease in this population. We sought to describe the experience at our center with catheter ablation in children <15 kg and compare the safety and efficacy of this procedure as it related to the presence of congenital …

Effect of congenital heart disease on child growth

Background: Children with congenital heart disease are prone to malnutrition and growth retardation. Aim: To compare growth status between children with CHD and healthy children.Materials and Methods: This casecontrol study included 40 children with congenital heart disease and 40 healthy children matched in age and gender. The age was from 3 months to 36 months. Congenital heart disease patients grouped according to cardiac diagnosis: Ventricular Septal defect, Atrial Septal Defect, Tetralogy of Falot, and Transposition of Greater Arteries. Anthropometric measurements of weight (Kilogram), height (Centimeter), and head circumference (centimeter) were measured and recorded for both case and control groups. Descriptive and analytical statistics were performed using the by the Statistical Package for the Social Sciences (SPSS) version 23.0.Results: Weight, height and head circumference were significantly lower in congenital heart disease children compared to healthy children (p-value

Effect of Congenital Heart Disease Status on Trends in Pediatric Infective Endocarditis Hospitalizations in the United States Between 2000 and 2012.

The purpose of this study was to create national estimates for the incidence of pediatric infective endocarditis (IE) in the United States and to determine if these changed after the implementation of the 2007 American Heart Association IE guidelines. It also sought to determine the effect of congenital heart disease (CHD) status on outcomes in IE. Hospital discharges with the diagnosis of IE in patients<18years old from the Kids' Inpatient Database were identified from the years 2000, 2003, 2006, 2009, and 2012. Discharges were grouped into Pre- and Post-2007 groups to facilitate analysis surrounding the implementation of the guidelines in 2007. Patients were categorized by age, underlying CHD, and etiologic organism. Descriptive comparisons and changes in categorical variables were made between groups. Average annual IE hospitalization rates before and after the 2007 guidelines were 10.8 and 9.3 per 1,000,000 children, respectively. The proportion of IE patients with CHD was stable between time periods, (45% vs. 47%, p = 0.50). Mortality was higher in the Post-2007 time period for CHD patients than non-CHD patients (11.1% vs. 2.4%, respectively; p < 0.001), while there was no difference noted during the Pre-2007 time period (6.5% vs. 6.6%, respectively; p = 0.95). Streptococcus was more common among CHD patients than non-CHD patients (27% vs. 17%), while Staphylococcus was more common among non-CHD patients than CHD patients (34% vs. 24%, p < 0.001). Even though the incidence of IE was stable over time, mortality was higher in CHD patients after the implementation of the 2007 AHA IE prophylaxis guidelines.

Additive effect of congenital heart disease and early developmental disorders on attention-deficit/hyperactivity disorder and autism spectrum disorder: a nationwide population-based longitudinal study.

In this retrospective nationwide population-based case-control study, we investigated the impact of congenital heart disease (CHD) on the development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which remains unclear. Children aged <18years that were diagnosed with CHD (n=3552) between January 1, 1997 and December 31, 2009 were identified from the National Health Insurance Research Database in Taiwan. Non-CHD controls (n=14,208) matched for age and sex (1:4) were selected from the same dataset. All subjects were observed until December 31, 2011 or their death. Comorbid perinatal conditions and early developmental disorders (EDD) that were diagnosed before ADHD and ASD diagnosis were also analyzed. The incidence rates of perinatal comorbidities, EDD, ADHD, and ASD were higher in the CHD group than in the control group. Multivariate Cox regression analysis revealed that the CHD group had an increased risk of developing ADHD (adjusted hazard ratio [aHR] 2.52, 95% confidence interval CI 1.96-3.25) and ASD (aHR 1.97, 95% CI 1.11-3.52) after adjusting for confounding comorbidities. EDD, but not perinatal comorbidities were also independent risk factors for ADHD and ASD after adjustment. Subgroup analysis indicated that the risk for ADHD (HR 16.59, 95% CI 12.17-22.60) and ASD (HR 80.68, 95% CI 39.96-176.12) was greatly increased in CHD subjects with EDD than in non-CHD subjects without EDD. These findings suggested that CHD at birth and EDD during early childhood were two independent risk factors for ADHD and ASD and that concurrent CHD and EDD might additively increase these risks.

Effect of congenital heart disease on 4-year neurodevelopment within multiple-gestation births

ObjectivesWe sought to assess the effect of congenital heart disease requiring infant surgery with cardiopulmonary bypass on neurodevelopmental outcomes and growth at 4 years of age, while matching for gestational age, socioeconomic status, maternal gestational conditions, home environment, and parental intelligence by studying multiple-gestation births. MethodsWe performed within-family comparison of 14 multiple-gestation births in which 1 child had congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age. Between 4 and 5 years of age, a comprehensive neurodevelopmental assessment was performed. Paired comparisons were conducted between siblings with and without heart defects using a series of nonparametric tests. ResultsOn average, the children qualified as late preterm (mean gestational age 35.4 ± 2.6 weeks). At an average age of 4.8 ± 0.1 years, children with congenital heart disease weighed less than their siblings (median weight for age z score −0.4 vs 0.1, P = .02) and had worse performance for cognition (median full-scale IQ 99 vs 109, P = .02) and fine motor skills (median Wide Range Assessment of Visual Motor Ability, Fine Motor score 94.5 vs 107.5, P < .01). ConclusionsAfter controlling for socioeconomic status, home environment, parental intelligence, and gestational factors by using multiple-gestation births, congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age is associated with lower weight, cognitive abilities and fine motor skills at 4 years of age.

Brain volumes predict neurodevelopment in adolescents after surgery for congenital heart disease

Patients with complex congenital heart disease are at risk for neurodevelopmental impairments. Evidence suggests that brain maturation can be delayed and pre- and postoperative brain injury may occur, and there is limited information on the long-term effect of congenital heart disease on brain development and function in adolescent patients. At a mean age of 13.8 years, 39 adolescent survivors of childhood cardiopulmonary bypass surgery with no structural brain lesions evident through conventional cerebral magnetic resonance imaging and 32 healthy control subjects underwent extensive neurodevelopmental assessment and cerebral magnetic resonance imaging. Cerebral scans were analysed quantitatively using surface-based and voxel-based morphometry. Compared with control subjects, patients had lower total brain (P = 0.003), white matter (P = 0.004) and cortical grey matter (P = 0.005) volumes, whereas cerebrospinal fluid volumes were not different. Regional brain volume reduction ranged from 5.3% (cortical grey matter) to 11% (corpus callosum). Adolescents with cyanotic heart disease showed more brain volume loss than those with acyanotic heart disease, particularly in the white matter, thalami, hippocampi and corpus callosum (all P-values < 0.05). Brain volume reduction correlated significantly with cognitive, motor and executive functions (grey matter: P < 0.05, white matter: P < 0.01). Our findings suggest that there are long-lasting cerebral changes in adolescent survivors of cardiopulmonary bypass surgery for congenital heart disease and that these changes are associated with functional outcome.

Effects of congenital heart disease on brain development

Brain and heart development occurs simultaneously in the fetus with congenital heart disease. Early morphogenetic programs in each organ share common genetic pathways. Brain development occurs across a more protracted time-course with striking brain growth and activity-dependent formation and refinement of connections in the third trimester. This development is associated with increased metabolic activity and the brain is dependent upon the heart for oxygen and nutrient delivery. Congenital heart disease leads to derangements of fetal blood flow that result in impaired brain growth and development that can be measured with advanced magnetic resonance imaging. Delayed development results in a unique vulnerability to cerebral white matter injury in newborns with congenital heart disease. Delayed brain development and acquired white matter injury may underlay mild but pervasive neurodevelopmental impairment commonly observed in children following neonatal congenital heart surgery.

Congenital heart disease affects local gyrification in 22q11.2 deletion syndrome

22q11.2 deletion syndrome (22q11.2DS) is a common genetic condition associated with cognitive and learning impairments. In this study, we applied a three-dimensional method for quantifying gyrification at thousands of points over the cortical surface to imaging data from 44 children, adolescents, and young adults with 22q11.2DS (17 males, 27 females; mean age 17y 2mo [SD 9y 1mo], range 6-37y), and 53 healthy participants (21 males, 32 females; mean age 15y 4mo [SD 8y 6mo]; range 6-40y). Several clusters of reduced gyrification were observed, further substantiating the pattern of cerebral alterations presented by children with the syndrome. Comparisons within 22q11.2DS demonstrated an effect of congenital heart disease (CHD) on cortical gyrification, with reduced gyrification at the parieto-temporo-occipital junction in patients with CHD, as compared with patients without CHD. Reductions in gyrification can resemble mild polymicrogyria, suggesting early abnormal neuronal proliferation or migration and providing support for an effect of hemodynamic factors on brain development in 22q11.2DS. The results also shed light on the pathophysiology of acquired brain injury in other populations with CHD.

Effect of congenital heart disease on neurodevelopmental outcomes within multiple-gestation births

We sought to assess the effect of congenital heart disease requiring surgical intervention with cardiopulmonary bypass at 6 months of age or less on developmental outcomes and growth at 1 year of age while controlling for socioeconomic status, prematurity, home environment, and parental intelligence. We performed within-family comparison of 11 multiple-gestation births in which one child had congenital heart disease. At 1 year of age, the Bayley Scales of Infant Development II were administered, and growth parameters were assessed. Paired comparisons were made by using fixed effects regression conditioned on family. The multiple-gestation subjects were mildly premature on average (mean gestational age, 35.4 +/- 3.0 weeks). At 1 year of age, children with congenital heart disease scored lower on the Mental Development Index (85.0 +/- 19.3 vs 93.9 +/- 16.0, P = .037) and the Psychomotor Development Index (76.6 +/- 16.9 vs 91.3 +/- 14.9, P = .015) on the Bayley Scales of Infant Development II than did their siblings without congenital heart disease. There were no differences between siblings in weight, height, or head circumference. The presence of congenital heart disease requiring surgical intervention with cardiopulmonary bypass at 6 months of age or less is associated with a deficit in developmental achievement at 1 year of age, as measured by using the Bayley Scales of Infant Development II.

Effect of Congenital Heart Disease on Renal Function in Childhood

Background: Nephropathy is a well-known complication of congenital heart disease (CHD), and the risk of developing renal impairment is particularly high in patients with cyanotic CHD. Most investigations of renal impairment in CHD have involved patients 20 years and older. This study investigated renal tubule function in pediatric patients with CHD, and compared findings in cyanotic and acyanotic groups. Methods: Twenty children with acyanotic CHD, 23 children with cyanotic CHD, and 13 healthy children were enrolled. Blood and early morning urine samples were collected from each subject to measure urinary concentrations of sodium, microalbumin, creatinine, β₂-microglobulin, and N-acetyl-β-D-glucosaminidase (NAG). Results: The age and sex distributions in the three groups were similar. Median fractional excretion of sodium (FeNa) and urinary NAG/creatinine were significantly higher in the cyanotic group than in the control group (p = 0.022 and p = 0.002, respectively). There were no statistically significant differences among the groups with respect to urinary β₂-microglobulin/creatinine, urinary microalbumin/creatinine or glomerular filtration rate. Conclusion: Tubular injury can be detected before glomerular injury occurs even within the first decade of life in patients with cyanotic CHD.