Project Details

Improving neurodevelopment in children with congenital heart disease: An intervention study

Johanna Calderon, PhD, MS

Summary

BACKGROUND: Congenital heart disease (CHD) is the most common birth defect and neurodevelopmental dysfunction, particularly executive dysfunction, is the most frequent long-term morbidity in youth with CHD. GAP: Deficits in executive function are at the heart of the neurodevelopmental phenotype in children and adolescents with CHD. The identification and treatment of neurodevelopmental morbidity constitute a primary aim in medical care and a public health priority as the number of individuals with CHD soars; however, to date, no study has investigated the efficacy of neurocognitive interventions aimed at preventing, reducing or compensating for these frequent morbidities. HYPOTHESIS: Hypothesis 1: Adolescents who receive the intervention (intervention group), compared to a control group receiving standard of care, will display greater improvement from baseline to immediate post-treatment on all neurodevelopmental assessments. Hypothesis 2: Significant gains in neurodevelopmental scores will persist 3 months after the end of the intervention. Hypothesis 3: Univentricular heart anatomy and/or a larger number of open-heart surgeries are associated with larger positive effects on neurodevelopment at immediate post-treatment and at 3-month follow-up in the intervention group. METHODS: This is a single-center, single-blinded RCT of the efficacy of a computerized neurocognitive intervention in young adolescents with CHD after infant open-heart surgery. Adolescents with a diagnosis of critical CHD requiring open-heart surgery, aged between 13 and 16 years at the time of enrollment and followed-up at Boston Children’s Hospital, Department of Cardiology. RESULTS: Sixty adolescents with CHD participated (28 assigned to Cogmed). No improvement at the post-treatment or 3-month follow-up assessments was found for the primary outcome measure of working memory. Compared with the control group, participants assigned to the intervention demonstrated benefits in inhibitory control and attention at the 3-month follow-up (p=0.02) and in parent-reported cognitive regulatory skills at post-treatment and 3-month follow-up (p=0.02 and p=0.04, respectively). Preterm birth, biventricular CHD and history of ADHD diagnosis were associated with improved response to the intervention. CONCLUSIONS: Cogmed intervention produced improvements in the self-regulatory control abilities of adolescents with CHD. The training did not enhance other areas of executive function or behavioral outcomes. Further studies are needed to evaluate the longer-term potential benefits to other domains.

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