Sanz Jacqueline H, Berl Madison M, Armour Anna C, Wang Jichuan, Cheng Yao I, Donofrio Mary T
Division of Neuropsychology, Children's National Health System, Washington, District of Columbia, USA.
Departments of Psychiatry and Behavioral Sciences & Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia, USA.
Congenit Heart Dis. 2017 Mar;12(2):202-209. doi: 10.1111/chd.12427. Epub 2016 Nov 11.
Executive function, a set of cognitive skills important to social and academic outcomes, is a specific area of cognitive weakness in children with congenital heart disease (CHD). We evaluated the prevalence and profile of executive dysfunction in a heterogeneous sample of school aged children with CHD, examined whether children with executive dysfunction are receiving school services and support, and identified risk factors for executive dysfunction at school age.
Ninety-one school aged patients completed questionnaires, including the Behavior Rating Inventory of Executive Function (BRIEF) and a medical history questionnaire. An age- and gender- matched control sample was drawn from a normative database.
Children with CHD had a higher rate of parent reported executive dysfunction (OR = 4.37, P < .0001), especially for working memory (OR = 8.22, P < .0001) and flexibility (OR = 8.05, P < .0001). Those with executive dysfunction were not more likely to be receiving school services (P > .05). Gender, premature birth (≤37 weeks), and CHD with aortic obstruction were predictive of executive dysfunction, especially for behavior regulation skills.
School aged children with CHD have an increased prevalence of executive dysfunction, especially problems with working memory and flexibility, and are underserved by the school system. The increased risk for executive dysfunction in those with CHD and prematurity or CHD with aortic obstruction suggests an etiology of delayed brain development in the fetal and neonatal periods, while male gender may increase susceptibility to brain injury. This study highlights the need for regular neurodevelopmental follow up in children with CHD, and a need to better understand mechanisms that contribute to adverse neurodevelopmental outcomes.
执行功能是一组对社交和学业成绩很重要的认知技能，是先天性心脏病（CHD）患儿认知功能的一个特定薄弱领域。我们评估了患有CHD的学龄儿童异质样本中执行功能障碍的患病率和特征，研究了患有执行功能障碍的儿童是否正在接受学校服务和支持，并确定了学龄期执行功能障碍的危险因素。
91名学龄患者完成了问卷，包括执行功能行为评定量表（BRIEF）和病史问卷。从一个标准化数据库中抽取年龄和性别匹配的对照样本。
CHD患儿家长报告的执行功能障碍发生率较高（比值比[OR]=4.37，P<.0001），尤其是在工作记忆（OR=8.22，P<.0001）和灵活性方面（OR=8.05，P<.0001）。患有执行功能障碍的儿童接受学校服务的可能性并不更高（P>.05）。性别、早产（≤37周）和伴有主动脉梗阻的CHD可预测执行功能障碍，尤其是在行为调节技能方面。
患有CHD的学龄儿童执行功能障碍的患病率增加，尤其是工作记忆和灵活性方面的问题，并且学校系统对他们的服务不足。患有CHD且早产或伴有主动脉梗阻的CHD患儿执行功能障碍风险增加，提示在胎儿期和新生儿期脑发育延迟的病因，而男性可能增加脑损伤的易感性。这项研究强调了对CHD患儿进行定期神经发育随访的必要性，以及更好地了解导致不良神经发育结局的机制的必要性。
