Objective

To characterize the neuropsychological outcome of children with congenital heart disease (CHD) at age 5 years; the stability of cognitive and language abilities across childhood; and to identify early neurodevelopmental markers of neuropsychological outcomes in these children.

Study design

Five-year-old children (n = 55) with complex CHD were assessed using standardized and comprehensive neuropsychological measures. Stability of language and cognitive performance was assessed by comparing standardized scores between ages 1, 2, and 5 years old. Association between 5-year-old skills and scores obtained in early childhood was studied to identify potential early markers of preschool performance. Receiver operating characteristic curves were used to evaluate the classification accuracy of Bayley Scales of Infant Development, Third Edition scales in identifying later impairments.

Results

At age 5 years, our cohort obtained scores significantly below the norms on most developmental domains, with 35% to 65% of participants showing impaired short-term/working memory, attention, and preacademic skills. Developmental patterns measured between ages 1 and 5 years were different for cognitive and language domains, with a decline with age for cognitive functioning and stable results for expressive language. The Bayley Scales of Infant Development, Third Edition language scores at age 2 years provided a good predictive value in identifying children with impaired language at age 5 years.

Conclusions

In our cohort, we found a high prevalence of impairments affecting higher-order cognitive domains. Although language difficulties can be detected as early as 2 years of age, other neuropsychological impairments, such as attention and pre-academic skills, only appear later during development, which reinforces the need for long-term monitoring and systematic assessment before school entry.

中文翻译：

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先天性心脏病儿童的神经发育结局：从婴儿到学龄前的队列研究

客观的

描述先天性心脏病 (CHD) 儿童在 5 岁时的神经心理结果；整个童年时期认知和语言能力的稳定性；并确定这些儿童神经心理结果的早期神经发育标志物。

学习规划

使用标准化和全面的神经心理学措施对患有复杂 CHD 的 5 岁儿童 (n = 55) 进行评估。通过比较 1、2 和 5 岁之间的标准化分数来评估语言和认知能力的稳定性。研究了 5 岁技能与儿童早期获得的分数之间的关联，以确定潜在的学龄前表现的早期标志。接受者操作特征曲线用于评估贝利婴儿发育量表第三版量表在识别后期损伤方面的分类准确性。

结果

在 5 岁时，我们的队列在大多数发展领域的得分明显低于标准，35% 到 65% 的参与者表现出短期/工作记忆、注意力和学前技能受损。1 至 5 岁之间测量的认知和语言领域的发育模式不同，认知功能随着年龄的增长而下降，而表达语言的结果稳定。贝利婴儿发展量表第三版 2 岁时的语言分数为识别 5 岁时语言受损的儿童提供了良好的预测价值。

结论

在我们的队列中，我们发现影响高阶认知领域的障碍的发生率很高。虽然语言障碍早在 2 岁就可以被发现，但其他神经心理障碍，如注意力和学前技能，只会在发育后期出现，这就加强了在入学前进行长期监测和系统评估的必要性。