Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada.
Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada.
J Pediatr. 2021 Dec;239:126-135.e5. doi: 10.1016/j.jpeds.2021.08.042. Epub 2021 Aug 27.
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.
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.
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.
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.
描述 5 岁患有先天性心脏病 (CHD) 的儿童的神经心理学结果；在整个儿童期认知和语言能力的稳定性；并确定这些儿童神经心理学结果的早期神经发育标志物。
使用标准化和全面的神经心理学评估方法对 5 岁患有复杂 CHD 的儿童进行评估。通过比较 1 岁、2 岁和 5 岁的标准化评分来评估语言和认知表现的稳定性。研究 5 岁时的技能与早期获得的分数之间的关联，以确定学龄前表现的潜在早期标志物。使用受试者工作特征曲线来评估贝利婴幼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。
在 5 岁时，我们的队列在大多数发育领域的得分明显低于正常水平，35%至 65%的参与者表现出短期/工作记忆、注意力和前学术技能受损。1 岁至 5 岁之间测量的发展模式在认知和语言领域有所不同，认知功能随年龄下降，而表达性语言则保持稳定。2 岁时的贝利婴幼儿发育量表第三版语言评分在识别 5 岁时语言受损的儿童方面具有良好的预测价值。
在我们的队列中，我们发现了较高比例的认知领域受损。尽管语言困难早在 2 岁时就可以检测到，但其他神经心理学损伤，如注意力和前学术技能，仅在发育后期出现，这进一步强调了在入学前需要进行长期监测和系统评估。
