Neurodevelopmental outcomes in preschool children with congenital heart defects: A case-control study using Ages & Stages Questionnaire.

There were no statistically significant differences in overall ASQ scores between children with CHD requiring surgery and healthy controls.

• 105 cases with any CHD had a median ASQ score of 230 (IQR 195-260) compared to 179 controls with 235 (IQR 205-265)
• p = 0.12
• Study included Danish children born between 2016-2018 who underwent surgery within the first year of life
• Neurodevelopmental outcome was assessed at 33-60 months using the Ages & Stages Questionnaire (ASQ)

Cases with CHD had a five-fold increased odds of a low ASQ score compared to controls after adjusting for covariates.

• OR 5.02 (95% CI 1.49–16.90)
• Adjusted for maternal educational level and children's age at ASQ completion
• Analysis performed using logistic regression

The increased odds of a low ASQ score in CHD cases was primarily driven by children with prenatally undetected VSD.

• 20% of children with prenatally undetected VSD scored below -2 standard deviations
• No differences in ASQ scores were found across individual CHD subgroups
• Ventricular Septal Defect (VSD) was one of six CHD subtypes included in the study

ASQ scores were lower in cases with prenatally undetected Transposition of the Great Arteries (TGA) compared to prenatally detected TGA, though the difference did not reach statistical significance.

• Cases with prenatally undetected TGA had a total ASQ score of 185 (IQR 145-190)
• Cases with prenatally detected TGA had a total ASQ score of 220 (IQR 190-270)
• p = 0.08

The study population was restricted to term, singleton-born children without genetic aberrations who underwent cardiac surgery within the first year of life.

• Exclusion criteria included preterm birth (<37 weeks), twins, and genetic aberrations
• Six CHD subtypes were included: VSD, atrioventricular septal defect, coarctation of the aorta, double outlet right ventricle, tetralogy of Fallot, and TGA
• Cases were matched with two to four healthy controls on age, sex, gestational age at delivery, and region of birth
• Comparisons were performed by the Mann-Whitney U test and logistic regression analysis

The authors concluded that all children with CHD requiring surgery should receive follow-up with awareness of potential developmental delays.

• Despite comparable overall scores, the five-fold increased odds of a low score in cases supports the need for monitoring
• Lower scores in prenatally undetected CHD, particularly VSD and TGA, highlight prenatal detection as a potentially relevant factor
• The findings apply to preschool-aged children assessed at 33-60 months