Congenital heart disease in school-aged children: Cognition, education, and participation in leisure activities

Spillmann, Rebecca C.; Polentarutti, Susanne; Ehrler, Melanie; Kretschmar, Oliver; Wehrle, Flavia M.; Latal, Beatrice · 2021 · OpenAlex-citations

DOI: 10.1038/s41390-021-01853-4

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Summary

This study investigates the long-term neurodevelopmental outcomes of school-aged children with congenital heart disease (CHD), specifically examining how cognitive deficits impact educational attainment and participation in leisure activities. Motivated by the known risk of neurodevelopmental sequelae in children undergoing cardiopulmonary bypass (CPB) surgery, the research aimed to characterize the cognitive profile of a contemporary cohort and determine the association between these cognitive functions and real-world functioning. The researchers utilized data from the prospective REACHOUT cohort, assessing 134 children at 10 years of age who had undergone CPB surgery before age six. Cognitive abilities were evaluated using the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) for IQ and the Behavior Rating Inventory of Executive Functions (BRIEF) for executive functions, with reports from both parents and teachers. Educational status and leisure activity participation were recorded via parental reports. Statistical analyses, including ordinal regression, assessed the associations between cognitive metrics and educational or leisure outcomes, controlling for socioeconomic status and medical risk factors. The results indicated that children with CHD exhibited significantly lower total IQ, working memory, and processing speed compared to population norms. While verbal comprehension and perceptual reasoning remained within average ranges, 24.6% of the cohort had a total IQ below 85, significantly higher than the normative prevalence. Executive function assessments revealed that teacher-reported metacognition was significantly impaired, and a higher proportion of children showed clinically significant executive dysfunctions in global executive function, metacognition, and behavioral regulation compared to norms. Consequently, only 82.4% of the children attended regular schools, compared to 97% of the general Swiss population, with many requiring additional educational support. Regarding leisure activities, 75% of the children participated in at least one activity, such as sports or music. The study found that lower total IQ and poorer teacher-rated executive functions were significantly associated with increased need for educational support. Furthermore, lower IQ was linked to reduced participation in leisure activities. These findings demonstrate that despite improvements in surgical care, children with CHD remain at risk for specific cognitive deficits that negatively affect their educational trajectories and social integration. The authors conclude that routine follow-up and early detection of cognitive impairments are essential to provide optimal support for educational success and leisure participation in this population.

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• cognitive impairment