Neurodevelopmental outcomes for children with hypoplastic left heart syndrome at the age of 5 years

Abstract

This study aimed to determine the neurodevelopmental (ND) outcome for children with hypoplastic left heart syndrome (HLHS) at early school age. English-speaking patients who underwent the Norwood procedure between 2000 and 2005 were eligible at 4-6 years of age for ND testing. Of the 72 eligible patients, 44 (61 %) agreed to participate, and 37 completed ND testing before the close of the study. Three subjects were excluded from analyses due to late stroke. The ND testing included intelligence, visual motor integration, memory and motor and language skills. Parents and teachers completed measures of behavior and attention problems. Subjects' scores and parent/teacher ratings were converted to z-scores and compared with test norms. Higher scores on child measures represent better outcomes, whereas higher scores on parent and teacher rating scales indicate more problems. The average ND performance of the tested cohort fell within one standard deviation of the test norms for all measures. However, the subjects performed significantly lower than the test norms on measures of visual-motor integration, fine motor skills, memory, and word structure (z = -0.42 to -0.54; p < 0.005). On the parent and teacher completed measures, the subjects scored higher than the test norms on attention problems (z = 0.40-0.62; p < 0.005). Although the overall ND performance of the cohort was normal, the subjects showed relative weakness in visual motor and attention skills. Ongoing developmental monitoring of these children is recommended to guide interventions that may improve individual outcomes and to assess the impact of changes in clinical management strategies on functional outcomes.

Conflict of interest statement

Conflicts of interest The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest to disclose.

Figures

Fig. 1

Neurodevelopmental (ND) testing results. a Star plot of mean ND test scores versus test norms. b Percentage of patients in the normal, at-risk, and impaired ranges of the ND tests. Test norms are depicted by a z-score of 0. Higher scores indicate better performance. The expected values in a normal distribution are 84 % (normal), 14 % (at-risk), and 2.5 % (impaired)

Fig. 2

Parent/teacher rating scale results. a Star plot of mean parent/teacher scores versus test norms. b Percentage of patients in the normal, at-risk, and impaired ranges of the parent/teacher scales. Test norms are depicted by a z-score of 0. Higher scores indicate more problems. The expected values in a normal distribution are 84 % (normal), 14 % (at-risk), and 2.5 % [impaired parent (P), teacher (T)]