Neurocognition after paediatric heart surgery: a systematic review and meta-analysis

Caroline Sterken, Jurgen Lemiere, Ilse Vanhorebeek, Greet Van den Berghe, Dieter Mesotten, Caroline Sterken, Jurgen Lemiere, Ilse Vanhorebeek, Greet Van den Berghe, Dieter Mesotten

Abstract

Children with congenital heart disease (CHD) often experience difficulties in academic and daily functioning, which have been associated with intelligence and neurocognitive skills, including executive functions (EFs), attention and memory. We report the neurocognitive data of children with CHD who were included in the Leuven glucose control trial (LGC trial). Through a systematic review and meta-analysis, we aimed to find which neurocognitive functions are most consistently and prominently affected. 365 children with CHD and 216 healthy control children underwent extensive neurocognitive testing in the LGC trial. A comprehensive search of electronic databases PubMed, EMBASE and Cochrane was conducted for studies measuring intelligence, EFs, attention and memory in children who underwent heart surgery for CHD. Standardised mean differences (SMDs) between the CHD group and a healthy control group were calculated for these neurocognitive functions. LGC trial data were included in the meta-analysis. Twelve studies with a healthy control group were included in the meta-analysis, involving 647 patients with CHD and 633 controls. The CHD group (median age 7.35 years at testing) had worse scores than healthy control children, for all investigated neurocognitive functions. A medium SMD was found for intelligence (SMD=-0.53 (95% CI -0.68 to -0.38), p<0.00001). Alertness, an attentional function, was also consistently poorer in the CHD group. Memory was less affected, while EF had a medium SMD with large heterogeneity. Children with CHD risk displayed lower performance on intelligence and alertness assessment, which may contribute to difficulties in daily life and school. Heterogeneity in neurocognitive assessment and small sizes in most studies limit the interpretation.

Trial registration number: clinicaltrials.gov Identifier NCT00214916.

Figures

Figure 1
Figure 1
Flow diagram of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). 1Search strategy in eMethods 1. 2Manuscripts could be excluded for more than one reason (CHD, congenital heart disease).
Figure 2
Figure 2
Forest plot of intelligence (author/year/journal—CHD type). TGA, d-transposition of the great arteries; VSD, ventricular septal defect; TOF, tetralogy of Fallot; ASD, atrial septal defect; CHD, congenital heart disease; ECMO, extracorporeal membrane oxygenation; V.d.Rijken, Van der Rijken; cath, catheterisation; surg, surgery; CA, circulatory arrest; CPB, cardiopulmonary bypass.
Figure 3
Figure 3
Forest plot of attention (Att; alertness) non-reaction time (author/year/journal—CHD-type/attention measure). Att1, mean accuracy (%) Attention Network Test; Att2, visual attention (NEuroPSYchological Assessment, NEPSY); Att3, auditory attention (NEPSY); Att4, processing speed (Wechsler Intelligence Scale for Children, WISC-IV); Att5, delay task, vigilance hits; Att6, speed of information (BAS, British Ability Scales); VSD, ventricular septal defect; TOF, tetralogy of Fallot; ASD, atrial septal defect; CHD, congenital heart disease; ECMO, extracorporeal membrane oxygenation.
Figure 4
Figure 4
Forest plot of verbal memory (Mem; author/year/journal—CHD-type/memory measure). Mem1, sum of immediate and delayed verbal memory (Children’s Memory Scale, Word Pairs, proportion correct responses); Mem2, narrative memory (NEuroPSYchological Assessment, NEPSY); Mem3, verbal memory (Wide Range Assessment of Memory and Learning, WRAML); ASD, atrial septal defect; CHD, congenital heart disease; ECMO, extracorporeal membrane oxygenation.
Figure 5
Figure 5
Forest plot of EF (inhibition) RT (author/year/journal—CHD-type/EF measure). EF, executive function; RT, reaction time; EF-test1, incongruent stroop; EF-test2, stroop; EF-test3, conflict (Attention Network Test); EF-test4, inhibition (Amsterdam Neuropsychological Tasks); TGA, d-transposition of the great arteries; VSD, ventricular septal defect; TOF, tetralogy of Fallot; CHD, congenital heart disease.

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