Ragnhild Eek Brandlistuen
BACKGROUND: With recent advances in cardiac surgery and medical management of congenital heart defects (CHD), mortality rates in infants with CHD have declined remarkably. As the number of CHD survivors has increased, research has uncovered developmental impairments in a variety of domains at school-age. Because intervention could attenuate these impairments, early detection would be crucial. Presently, however, little is known about the occurrence and persistence of developmental impairments in early childhood. The aim of this dissertation was therefore to study developmental impairments during the first three years of life in children with CHD.
METHOD: Data from the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health, was linked with a nationwide medical CHD registry. Children with mild, moderate or severe CHD were compared with children without CHD on developmental impairments in motor, communication, and social domains. All information on child development was reported by mothers in MoBa questionnaires.
RESULTS: After adjusting for confounders (ie, birth weight) we found important differences between children with CHD and the same-aged controls from the MoBa. In early infancy two groups stood out as being particularly at risk for developmental impairments: Children with severe CHD showed higher odds for impairments in gross and fine motor skills. Children with CHD and comorbidity (such as intestinal malformations) showed developmental impairments across gross motor, fine motor, and social domains. At age 18 months the same two groups had more symptoms of communication impairments and social impairments than children without CHD. The largest differences from controls were found in children with CHD and comorbidity. At age 3 years children with severe CHD had higher odds for both gross motor and communication impairments compared with controls. Children with mild and moderate CHD had higher odds of gross motor impairments but did not otherwise differ from controls. In children with severe CHD predictors of impairments were previous developmental impairments, smaller head circumference at birth, being small for gestational age, and maternal distress.
CONCLUSION: Our findings are important for the understanding of early development in children with CHD. They underline that clinicians should be attentive to early developmental impairments and the condition of the child at birth in order to provide individualized interventions that may improve developmental outcomes in children with CHD.