Neurocognitive outcome of school-aged children with congenital heart disease who underwent cardiopulmonary bypass surgery: a systematic review protocol

Feldmann, Maria; Ullrich, Cinzia; Bataillard, Célina; Knirsch, Walter; Gosteli-Peter, Martina A.; Latal, Beatrice; Held, Ulrike · 2019 · Crossref

DOI: 10.1186/s13643-019-1153-y

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Summary

This document is a protocol for a systematic review, not a completed study. It outlines the planned methodology for investigating the neurocognitive outcomes of school-aged children with congenital heart disease (CHD) who underwent cardiopulmonary bypass surgery. The research is motivated by the dramatic increase in CHD survival rates, which has shifted clinical focus toward long-term extracardiac comorbidities, particularly neurodevelopmental sequelae. While impairments in infancy are well-documented, there is substantial variability in existing literature regarding CHD types, assessment ages, and test batteries. Furthermore, executive function impairments in this population remain poorly understood. The review aims to determine the impact of CHD on intellectual outcomes and executive functioning at school age and to identify risk factors for impaired outcomes. The methodology adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols (PRISMA-P) guidelines and is registered with PROSPERO. The review will search databases including Cochrane, EMBASE, MEDLINE, and PsycINFO without restrictions on publication date or language. Eligible studies include original, peer-reviewed research involving school-aged children (5–17 years) with CHD who underwent surgical repair or palliation with cardiopulmonary bypass. Studies focusing exclusively on children with neurologic comorbidities or after heart transplantation are excluded. Primary outcomes are intelligence quotient (IQ) and executive function scores. Secondary outcomes include measures of academic achievement. Data extraction will be performed by independent reviewers, with discrepancies resolved by a third party. The protocol specifies handling of missing data through author contact or multiple imputation and assessment of methodological quality using SIGN checklists. Statistical synthesis will involve meta-analysis if three or more studies report comparable outcomes, using fixed or random effects models based on heterogeneity measured by Higgins’s I2 statistic. Subgroup analyses are planned for variables such as CHD type (cyanotic vs. acyanotic), age at surgery, age at assessment, and socioeconomic status. If meta-analysis is not feasible due to heterogeneity or low study numbers, a narrative synthesis will be conducted. Publication bias will be assessed using funnel plots and the Egger test, while the confidence in cumulative evidence will be graded using the GRADE approach. The significance of this review lies in its potential to summarize current evidence on cognitive and executive function outcomes, thereby aiding clinicians in counseling patients and families. By identifying modifiable surgical and perioperative risk factors, the findings are expected to inform the establishment of tailored follow-up programs and interventional trials. Additionally, the review aims to help researchers detect knowledge gaps and pose future research questions regarding the multifactorial mechanisms leading to neurodevelopmental sequelae in children with CHD.

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• cognitive capacity variation