Maria Feldmann1,2, Célina Bataillard1,2, Melanie Ehrler1,2, Cinzia Ullrich1,2, Walter Knirsch2,3, Martina A Gosteli-Peter4, Ulrike Held5, Beatrice Latal6,2. 1. Child Development Centre and Children's Research Centre. 2. Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland. 3. Pediatric Cardiology, Pediatric Heart Center, and. 4. Main Library. 5. Department of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland. 6. Child Development Centre and Children's Research Centre bea.latal@kispi.uzh.ch.
Abstract
CONTEXT: Cognitive function and executive function (EF) impairments contribute to the long-term burden of congenital heart disease (CHD). However, the degree and profile of impairments are insufficiently described. OBJECTIVE: To systematically review and meta-analyze the evidence on cognitive function and EF outcomes in school-aged children operated for CHD and identify the risk factors for an unfavorable outcome. DATA SOURCES: Cochrane, Embase, Medline, and PsycINFO. STUDY SELECTION: Original peer-reviewed studies reporting cognitive or EF outcome in 5- to 17-year old children with CHD after cardiopulmonary bypass surgery. DATA EXTRACTION: Results of IQ and EF assessments were extracted, and estimates were transformed to means and SE. Standardized mean differences were calculated for comparison with healthy controls. RESULTS: Among 74 studies (3645 children with CHD) reporting total IQ, the summary estimate was 96.03 (95% confidence interval: 94.91 to 97.14). Hypoplastic left heart syndrome and univentricular CHD cohorts performed significantly worse than atrial and ventricular septum defect cohorts (P = .0003; P = .027). An older age at assessment was associated with lower IQ scores in cohorts with transposition of the great arteries (P = .014). Among 13 studies (774 children with CHD) reporting EF compared with controls, the standardized mean difference was -0.56 (95% confidence interval: -0.65 to -0.46) with no predilection for a specific EF domain or age effect. LIMITATIONS: Heterogeneity between studies was large. CONCLUSIONS: Intellectual impairments in CHD are frequent, with severity and trajectory depending on the CHD subtype. EF performance is poorer in children with CHD without a specific EF profile. The heterogeneity in studied populations and applied assessments is large. A uniform testing guideline is urgently needed.
CONTEXT: Cognitive function and executive function (EF) impairments contribute to the long-term burden of congenital heart disease (CHD). However, the degree and profile of impairments are insufficiently described. OBJECTIVE: To systematically review and meta-analyze the evidence on cognitive function and EF outcomes in school-aged children operated for CHD and identify the risk factors for an unfavorable outcome. DATA SOURCES: Cochrane, Embase, Medline, and PsycINFO. STUDY SELECTION: Original peer-reviewed studies reporting cognitive or EF outcome in 5- to 17-year old children with CHD after cardiopulmonary bypass surgery. DATA EXTRACTION: Results of IQ and EF assessments were extracted, and estimates were transformed to means and SE. Standardized mean differences were calculated for comparison with healthy controls. RESULTS: Among 74 studies (3645 children with CHD) reporting total IQ, the summary estimate was 96.03 (95% confidence interval: 94.91 to 97.14). Hypoplastic left heart syndrome and univentricular CHD cohorts performed significantly worse than atrial and ventricular septum defect cohorts (P = .0003; P = .027). An older age at assessment was associated with lower IQ scores in cohorts with transposition of the great arteries (P = .014). Among 13 studies (774 children with CHD) reporting EF compared with controls, the standardized mean difference was -0.56 (95% confidence interval: -0.65 to -0.46) with no predilection for a specific EF domain or age effect. LIMITATIONS: Heterogeneity between studies was large. CONCLUSIONS: Intellectual impairments in CHD are frequent, with severity and trajectory depending on the CHD subtype. EF performance is poorer in children with CHD without a specific EF profile. The heterogeneity in studied populations and applied assessments is large. A uniform testing guideline is urgently needed.
Authors: Luregn J Schlapbach; Kristen S Gibbons; Stephen B Horton; Kerry Johnson; Debbie A Long; David H F Buckley; Simon Erickson; Marino Festa; Yves d'Udekem; Nelson Alphonso; David S Winlaw; Carmel Delzoppo; Kim van Loon; Mark Jones; Paul J Young; Warwick Butt; Andreas Schibler Journal: JAMA Date: 2022-07-05 Impact factor: 157.335
Authors: Eleonore S V de Sonnaville; Marsh Kӧnigs; Ouke van Leijden; Hennie Knoester; Job B M van Woensel; Jaap Oosterlaan Journal: BMC Med Date: 2022-06-01 Impact factor: 11.150