Child Development Center, University Children's Hospital, Zurich, Switzerland; Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital, Zurich, Switzerland; Children's Research Center, University Children's Hospital, Zurich, Switzerland.
Children's Research Center, University Children's Hospital, Zurich, Switzerland; Division of Biostatistics, Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
J Pediatr. 2019 Jan;204:24-30.e10. doi: 10.1016/j.jpeds.2018.08.060. Epub 2018 Oct 16.
To determine growth and its relationship to IQ in children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery within the first year of life.
Prospective single-center cohort study on 143 children (91 males) with different types of CHD (29 univentricular). Children with recognized genetic disorders were excluded. Growth (weight, height, and head circumference [HC]) was assessed at birth, before surgery, and at 1, 4, and 6 years and compared with Swiss growth charts. IQ was assessed at 6 years using standardized tests. Univariate and multivariable linear regressions were performed to determine predictors of HC and IQ at 6 years.
HC at birth was in the low average range (33rd percentile, P = .03), and weight (49th percentile, P = .23) and length (47th percentile, P = .06) were normal. All growth measures declined until the first surgery, with a catch-up growth until 6 years for height (44th percentile, P = .07) but not for weight (39th percentile, P = .003) or for HC (23rd percentile, P < .001). Children undergoing univentricular palliation showed poorer height growth than other types of CHD (P = .01). Median IQ at 6 years was 95 (range 50-135). Lower IQ at 6 years was independently predicted by lower HC at birth, lower socioeconomic status, older age at first bypass surgery, and longer length of intensive care unit stay.
Smaller HC at birth and postnatal factors are predictive of impaired intellectual abilities at school age. Early identification should alert clinicians to provide early childhood interventions to optimize developmental potential.
确定在生命的第一年接受体外循环心肺旁路手术的先天性心脏病（CHD）儿童的生长情况及其与智商（IQ）的关系。
对 143 名（91 名男性）不同类型 CHD（29 名单心室）患儿进行前瞻性单中心队列研究。排除了有明确遗传障碍的患儿。在出生时、手术前以及 1、4 和 6 岁时评估生长（体重、身高和头围[HC]），并与瑞士生长图表进行比较。在 6 岁时使用标准化测试评估智商。进行单变量和多变量线性回归，以确定 6 岁时 HC 和 IQ 的预测因素。
出生时 HC 处于中下等范围（第 33 百分位数，P=0.03），体重（第 49 百分位数，P=0.23）和身高（第 47 百分位数，P=0.06）正常。所有生长指标均下降，直至第一次手术，身高（第 44 百分位数，P=0.07）出现追赶性生长，但体重（第 39 百分位数，P=0.003）和 HC（第 23 百分位数，P<0.001）未出现追赶性生长。接受单心室姑息治疗的患儿身高生长较其他类型 CHD 更差（P=0.01）。6 岁时的中位智商为 95（范围 50-135）。6 岁时 IQ 较低与出生时 HC 较低、社会经济地位较低、首次体外循环手术年龄较大和重症监护病房停留时间较长有关。
出生时 HC 较小和出生后的因素可预测学龄期智力障碍。早期识别应提醒临床医生提供儿童早期干预措施，以优化发育潜力。
