Original Article
Impact of Prenatal Diagnosis on Neurocognitive Outcomes in Children with Transposition of the Great Arteries

https://doi.org/10.1016/j.jpeds.2011.12.036Get rights and content

Objectives

To assess the effect of prenatal diagnosis of congenital heart disease on neurocognitive outcomes in children with d-transposition of the great arteries (TGA) after surgical correction.

Study design

A prospective study of children born with a TGA between 2003 and 2005 and aged 4 to 6 years was conducted. General intelligence, language, executive functions, and social cognition scores and preoperative, intraoperative, and postoperative factors were evaluated according to time of TGA diagnosis. Neurocognitive data were also compared with a control group.

Results

Forty-five eligible patients (67% male) were examined; 29 had a prenatal diagnosis of TGA and 16 did not. All children were comparable in age, sex, and demographic variables. Diagnostic groups did not differ in preoperative, intraoperative, and postoperative variables. Preoperative acidosis was more frequent in the postnatal group (18% versus 3%). All patients had normal IQ scores, language, and verbal working memory. However, neurocognitive deficits were more prevalent and more severe in children with a postnatal-TGA. Prenatal diagnosis was associated with better outcomes in executive functions.

Conclusions

Prenatal diagnosis of TGA is associated with better neurocognitive outcomes. Time of diagnosis may influence the development of early complex cognitive skills such as executive functions.

Section snippets

Methods

All children born with a TGA between 2003 and 2005 were screened for enrollment in a single-center prospective study of neurocognitive outcomes conducted at Necker Children’s Hospital (Paris, France). Eligibility criteria included a diagnosis of TGA with intact ventricular septum or ventricular septal defect (VSD) in children who underwent a neonatal arterial switch operation with a single method of vital organ support (continuous full-flow cardiopulmonary bypass grafting). Exclusion criteria

Results

Sixty eligible children were identified in the database. Parents of 6 children declined to participate in the study, and two children were excluded because of developmental disorders not previously identified (autism spectrum disorder and severe language disability). Six families could not be contacted because of a change of address, and one child refused to cooperate with the administration of the tests. Therefore, 45 eligible children (75%) participated in the study. No significant

Discussion

Neurocognitive deficits in children with a d-TGA after surgical correction continue to be reported despite great progress in surgical management. Children with ductal-dependent lesions are at risk of ductal closure and therefore at high risk of acidosis, hypoxemia, and hypoxic-ischemic injury.18 Several studies have demonstrated an association between prenatal diagnosis of congenital heart disease (CHD), including TGA, and a significant decrease in preoperative morbidity.2, 3, 19 It has been

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    Supported by the association for research in cardiology from Foetus to Adults (Association pour la Recherche en Cardiologie du Foetus à l’Adulte), Necker Children’s Hospital, Paris, France. The authors declare no conflicts of interest.

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