47 - Early Language Development in Children with Critical Congenital Heart Disease

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 47
Publication Number: 47.446

Alexa C. Escapita, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Anna Gregg, Arkansas Children's Hospital, Conway, AR, United States; Julienne Thomas, Arkansas Children's Hospital, Little Rock, AR, United States; Kelsey R. Lambou, University of Kansas Medical Center, Kansas City, KS, United States; Elijah H.. Bolin, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Lawrence Greiten, Arkansas Children’s Hospital, Little Rock, AR, United States; Kenneth Knecht, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Brian Reemtsen, Arkansas Children's Hospital, Little Rock, AR, United States; Dala Zakaria, Arkansas Children's Hospital, Little Rock, AR, United States; Heather Watson, Arkansas Children's Hospital, North Little Rock, AR, United States; Tara L. Johnson, Arkansas Children's Hospital, Little Rock, AR, United States

Presenting Author(s)

Alexa C. Escapita, BS (she/her/hers)

PhD Candidate
University of Arkansas for Medical Sciences College of Medicine
Little Rock, Arkansas, United States

Background: Congenital heart disease (CHD) is the most common birth defect in the United States. Surgical advancements have increased survival and have shifted the focus from mortality to morbidity, such as neurodevelopmental disabilities (NDD). Children with critical CHD, including single ventricle physiology (SVP) and Transposition of the Great Arteries (TGA), are at the greatest risk for NDD. Children with SVP and TGA both have cerebral hypoxia in-utero and require early surgical intervention requiring heart-lung bypass. After their first surgery, children with SVP continue to have lower oxygen delivery to the brain, whereas children with TGA have normal oxygen delivery to the brain.

Objective: We compared language development in children with SVP and children with TGA from 0-36 months of age. We hypothesized that children with SVP and TGA would have different language developmental quotients (DQ) by 36 months of age.

Design/Methods: At Arkansas Children’s Hospital, our Cardiac Neurodevelopmental Program clinic assesses language development in all children with critical CHD with the Clinical Linguistic and Auditory Milestone Scales (CLAMS) component of the Capute Scales. Between January 2019 and November 2022, our program evaluated 32 children with SVP and TGA. We excluded children who were premature, had heart transplants, or had confirmed genetic syndromes. We compared DQ in 25 children with SVP and 7 with TGA. We created univariate linear regression models of the two groups' DQ over time and compared confidence intervals of their DQ at 36 months of age.

Results:
Both groups had downward trending DQ over time (Fig). Both groups of children with critical CHD were predicted to have age-appropriate DQ at 3 months of age, and borderline-mild DQ at 36 months of age.

Conclusion(s): As a whole, children with SVP and TGA have a detectable decrease in their language DQ by 36 months of age. Children with SVP and TGA have notable similarities, including in-utero cerebral hypoxia and heart-lung bypass within their first few weeks of life. Although children with TGA have normal cerebral oxygen after their initial surgery, their language development mirrors that of children with SVP, suggesting a strong effect of the intrauterine environment and early surgical interventions on language development. It is important to continue investigating the impact of the in-utero environment and early surgical intervention on language development through additional longitudinal studies on this high-risk population. We recommend that all children with CHD have close neurodevelopmental surveillance starting as early as infancy.