166 - Developmental trajectories in children with congenital heart disease

Poster Number: 166
Publication Number: 166.101

Tara L. Johnson, Arkansas Children's Hospital, Little Rock, AR, United States; Alexa Escapita, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Kelsey Lambou, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Julienne Daniel, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Namarta Kapil, University of Arkansas for Medical Sciences, North Little Rock, AR, United States; Heather Raiees-Dana, Arkansas Children's Hospital, North Little Rock, AR, United States; Beverly J. Spray, Arkansas Children's Hospital, North Little Rock, AR, United States; Lawrence Greiten, Arkansas Children's Hospital, Little Rock, AR, United States; Brian Reemtsen, Arkansas Children's Hospital, :Little Rock, AR, United States; Kenneth Knecht, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States

Background: Congenital heart disease (CHD) affects 1% of all live births in the United States. Patients with critical CHD, such as those with single ventricle physiology, are at great risk for neurodevelopmental disabilities (NDD) and subsequently poor quality of life. They usually have motor delays in infancy, behavioral problems in toddler years, and learning problems in school age. We hypothesize that children with CHD have early language and visual-motor delays prior to exhibiting behavioral problems.

Objective: A retrospective cohort study of infants with single ventricle physiology was performed to track developmental trajectories up to 27 months of age. We used the Capute Scales to quantify language and visual-motor development in this population.

Design/Methods: We identified a cohort of infants with single ventricle physiology from our Cardiac Neurodevelopmental Program. Assessments were performed at 0-9 months, 10-18 months, and 19-27 months. Using anecdotal evidence, we used the assumption that initial developmental quotients are approximately in the age-appropriate range to calculate a sample size with 80% power to detect clinically significant differences in developmental outcomes with alpha < 0.05.

Results: 16 patients were evaluated. Developmental trajectories are shown in Figures 1 and 2. For reference, we defined an age-appropriate developmental quotient as 85-115. Median and interquartile ranges are as follows. Language developmental quotients were 100 (100-108), 97 (90-100), and 70 (37-54) at 0-9 months, 10-18 months, and 19-27 months, respectively. Visual-motor developmental quotients were 100 (94-106), 97 (95-103), and 85 (74-90) at 0-9 months, 10-18 months, and 19-27 months, respectively. The decrease in developmental quotients between 10-18 months and 19-27 months was both clinically and statistically significant in both cases.Conclusion(s): Language and visual-motor delays are apparent by 19-27 months of age, and are targets for early intervention, such as speech and occupational therapies, to help mitigate emerging behavioral problems. Earlier delays by 18 months may not be detectable, as specificity of developmental milestones requires brain maturation. In addition, many of these children may have had temporary developmental regressions following their second surgery prior to their evaluation between 19-27 months. This strengthens the impetus for recurrent developmental evaluations to identify and treat new delays with targeted therapies, which will ultimately lead to better neurodevelopmental outcomes and quality of life.
Figure 1. Language developmental trajectories of infants and toddlers with single ventricle physiology.The language developmental quotients in our cohort were in the age-appropriate range at 0-9 months and 10-18 months. The developmental quotients decreased to the borderline-mild delay range at 19-27 months (p < 0.001).
Figure 2. Visual-motor developmental trajectories of infants and toddlers with single ventricle physiology.The visual-motor developmental quotients in our cohort were in the age-appropriate range at 0-9 months and 10-18 months. The developmental quotients decreased to the borderline-mild delay range at 19-27 months (p=0.01).