Article Text

Review
Neurocognition after paediatric heart surgery: a systematic review and meta-analysis
  1. Caroline Sterken1,
  2. Jurgen Lemiere2,3,
  3. Ilse Vanhorebeek1,
  4. Greet Van den Berghe1 and
  5. Dieter Mesotten1
  1. 1Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
  2. 2Child and Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
  3. 3Paediatric Haemato-Oncology, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Dr Dieter Mesotten; dieter.mesotten{at}med.kuleuven.be

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.

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