Cognitive speech disorders in children with congenital heart defects aged 5–7 years

   Purpose. To found out expressive speech disorders as a sign of neurocognitive development delay in children with congenital heart defects before and after surgery.

   Material and methods: 216 children with congenital heart defects were divided into groups according to the presence (group 1, n = 71) and absence (group 2, n = 145) of family history confounding factors, and studied before surgery and in 1 and 2 years after definitive repair under cardiopulmonary bypass. The anamnesis, clinical and hemodynamic aspects were studied before and after surgery, mental status and expressive speech diagnostics were also performed.

   Results. The predictors of neurocognitive impairment in children with congenital heart defects before surgery were identified: the level of heart failure, comorbidity, burdened family history. 76.3 % of children had «average» level of neurocognitive development (more in group 2) in a year after surgical correction, while 23.6 % had «low» and «very low» level (more in group 1); there were general expressive speech disorders in 68 % children in group 1 and in 55 % in group 2 among all children. «High» level of neurocognitive development was recorded in 2 years (13.8 % among all children), while the number of children with general expressive speech disorders was approximately the same despite of positive dynamic of clinical and hemodynamic aspects.

   Conclusion. There are «low» levels of neurocognitive development and expressive speech disorders in children with congenital heart defects in long term postoperative period despite of clinical and hemodynamic normalization. It can predict significant risks and poor quality of life in the absence of timely correction.

1. Bokeriya L.A., Stupakov I.N., Miliyevskaya E.B., Krupyanko S.M., Nevedrova M.N. Analysis of the bed fund for providing medical care to children with congenital heart defects in the Russian Federation. Yuzhno-Ural’skiy meditsinskiy zhurnal 2017; 3: 4–11. (in Russ.)

2. Gonzalez V.J., Kimbro R.T., Cutitta K.E., Shabosky J.C., Bilal M.F., Penny D.J., Lopez K.N. Mental Health Disorders in Children With Congenital Heart Disease. Pediatrics 2021; 147(2): e20201693. DOI: 10.1542/peds.2020–1693

3. Warnes C.A., Liberthson R., Danielson G.K., Dore A., Harris L., Hoffman J.I. et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001; 37(5): 1170–1175. DOI: 10.1016/s0735–1097(01)01272–4

4. Mussatto K.A., Hoffmann R., Hoffman G., Tweddell J.S., Bear L., Cao Y. et al. Risk Factors for Abnormal Developmental Trajectories in Young Children With Congenital Heart Disease. Circulation 2015; 132(8): 755–761. DOI: 10.1161/CIRCULATIONAHA.114.014521

5. Baranov A.A., Maslova O.I., Namazova-Baranova L.S. Ontogenesis of neurocognitive development of children and adolescents. Vestnik Rossiyskoy akademii meditsinskikh nauk 2012; 67(8): 26–33. (in Russ.) DOI: 10.15690/vramn.v67i8.346

6. Uglov F.G., Gritsenko V.V., Likhnitskaya L.L. Topical issues of rehabilitation of patients with congenital heart defects. Bulletin of Surgery named after I. I. Grekov 1993; 173(3–4): 3–9. (in Russ.)

7. Leonard L.B. Is expressive language disorder an accurate diagnostic category? Am J Speech-Language Pathol 2009; 18(2): 115–123. DOI: 10.1044/1058–0360(2008/08–0064)

8. Limperopoulos C., Majnemer A., Shevell M.I., Rosenblatt B., Rohlicek C., Tchervenkov C. Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatri 2000; 137(5): 638–645. DOI: 10.1067/mpd.2000.109152

9. Li Y., Yin S., Fang J., Hua Y., Wang C., Mu D., Zhou K. Neurodevelopmental delay with critical congenital heart disease is mainly from prenatal injury not infant cardiac surgery: current evidence based on a meta-analysis of functional magnetic resonance imaging. Ultrasound Obstet Gynecol 2015; 45(6): 639–648. DOI: 10.1002/uog.13436

10. Fourdain S., St-Denis A., Harvey J., Birca A., Carmant L., Gallagher A., Trudeau N.; CINC team. Language development in children with congenital heart disease aged 12–24 months. Eur J Paediatr Neurol 2019; 23(3): 491–499. DOI: 10.1016/j.ejpn.2019.03.002

11. Turner T., El Tobgy N., Russell K., Day C., Cheung K., Proven S., Ricci M.F. Language abilities in preschool children with critical CHD: a systematic review. Cardiol Young 2022: 1–11. DOI: 10.1017/S1047951122001330

12. Berezin F.B., Beznosyuk E.V., Sokolova E.D. Psychological mechanisms of psychosomatic diseases. Rossiiskii meditsinskii zhurnal 1998: 5: 43–49. (in Russ.)

13. Bellinger D.C., Wypij D., duPlessis A.J., Rappaport L.A., Jonas R.A., Wernovsky G., Newburger J.W. Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126(5): 1385–1396. DOI: 10.1016/S0022–5223(03)00711–6

14. Mahle W.T., Clancy R.R., Moss E.M., Gerdes M., Jobes D.R., Wernovsky G. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics 2000; 105(5): 1082–1089. DOI: 10.1542/peds.105.5.1082

15. Hövels-Gürich H.H., Konrad K., Skorzenski D., Nacken C., Minkenberg R., Messmer B.J., Seghaye M.C. Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy. Ann Thorac Surg 2006; 81(3): 958–966. DOI: 10.1016/j.athoracsur.2005.09.010

16. Frazier M.S. Expressive Language. Editors Goldstein S., Naglieri J.A. Encyclopedia of Child Behavior and Development. Springer, Boston, MA; 2011: 620–621. DOI: 10.1007/978–0–387–79061–9_1060

17. Rollins C.K., Newburger J.W. Cardiology patient page Neurodevelopmental outcomes in congenital heart disease. Circulation 2014; 130(14): e124–e126. DOI: 10.1161/CIRCULATIONAHA.114.008556

18. Dimitropoulos A., McQuillen P.S., Sethi V., Moosa A., Chau V., Xu D. et al. Brain injury and development in newborns with critical congenital heart disease. Neurology 2013; 81(3): 241–248. DOI: 10.1212/WNL.0b013e31829bfdcf

19. Wernovsky G., Licht D.J. Neurodevelopmental Outcomes in Children With Congenital Heart Disease-What Can We Impact? Pediatr Crit Care Med 2016; 8: S232–S242. DOI: 10.1097/PCC.0000000000000800

20. Tsepokina A.V., Ponasenko A.V., Shabaldin A.V. Analysis of the relationships of GSTP1, CYP1A1, CYP1A2 genes in children with congenital heart defects. Rossiyskiy Vestnik Perinatologii i Pediatrii 2020; 65(3): 39–43. (in Russ.) DOI: 10.21508/1027–4065–2020–65–3–39–43