Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot

Jeffrey D Zampi; Dawn L Ilardi; Courtney E McCracken; Yun Zhang; Andrew C Glatz; Bryan H Goldstein; Christopher J Petit; Athar M Qureshi; Caren S Goldberg; Mark A Law; Jeffery J Meadows; Shabana Shahanavaz; Sarosh P Batlivala; Shiraz A Maskatia; Michael L O'Byrne; R Allen Ligon; Joelle A Pettus; Asaad Beshish; Jennifer C Romano; Kathryn O Stack; Hala Q Khan; Shalin Parekh; George T Nicholson

doi:10.1016/j.jpeds.2024.114357

Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot

J Pediatr. 2024 Oct 16:276:114357. doi: 10.1016/j.jpeds.2024.114357. Online ahead of print.

Authors

Jeffrey D Zampi¹, Dawn L Ilardi², Courtney E McCracken³, Yun Zhang⁴, Andrew C Glatz⁵, Bryan H Goldstein⁶, Christopher J Petit⁴, Athar M Qureshi⁷, Caren S Goldberg⁸, Mark A Law⁹, Jeffery J Meadows¹⁰, Shabana Shahanavaz¹¹, Sarosh P Batlivala¹¹, Shiraz A Maskatia¹², Michael L O'Byrne¹³, R Allen Ligon¹⁴, Joelle A Pettus¹⁴, Asaad Beshish¹⁴, Jennifer C Romano¹⁵, Kathryn O Stack¹³, Hala Q Khan⁷, Shalin Parekh¹⁰, George T Nicholson¹⁶

Affiliations

¹ Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: jzampi@med.umich.edu.
² Pediatric Neurodevelopmental Center, Atlanta, GA; Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
³ Center for Research and Evaluation, Kaiser Permanente, Atlanta, GA.
⁴ Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physicians & Surgeons, New York, NY.
⁵ Division of Cardiology, Department of Pediatrics, Washington University, St Louis, MO.
⁶ Department of Pediatrics, Heart Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA.
⁷ Lillie Frank Abercrombie Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
⁸ Division of Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI.
⁹ Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL.
¹⁰ Division of Cardiology, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA.
¹¹ The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH.
¹² Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
¹³ The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁴ Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
¹⁵ Division of Congenital Cardiothoracic Surgery, Department of Cardiothoracic Surgery, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI.
¹⁶ Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.

PMID: 39423907
DOI: 10.1016/j.jpeds.2024.114357

Abstract

Objective: To assess the association between primary and staged repair of neonatal symptomatic tetralogy of Fallot (sTOF) and neurodevelopmental outcomes in preschool through school-age children.

Study design: Multicenter cohort (n = 9 sites) study of patients with sTOF who underwent neonatal intervention between 2005 and 2017. The neurodevelopmental outcomes measures included caregivers' ratings of executive function with the Behavior Rating Inventory of Executive Function, and psychosocial functioning with the Behavior Assessment System for Children - third Edition (BASC-3). Results were compared with normative data and by treatment strategy (primary repair vs staged repair). A parent survey assessed history of disabilities and access to services related to neurodevelopment.

Results: Although the majority of patients (median age 8.3 years, IQR 5.7-11.2) had median Behavior Rating Inventory of Executive Function and BASC-3 scores within the normal range, a proportion had clinically elevated (abnormal) scores, especially in the school-age patient subgroup (Behavior Rating Inventory of Executive Function 24%-30% and BASC 20%-37%). There were no statistically significant differences based on treatment strategy for either the Behavior Rating Inventory of Executive Function or BASC-3. However, lower birth weight, genetic syndrome, and medical complexity were significantly associated with worse executive function, and lower maternal education was associated in school-age children with lower executive and psychosocial functioning. Ongoing disabilities were relatively common (learning disability 35%, speech delay 33%, developmental delay 31%), although up to 50% of children were not receiving educational or developmental services.

Conclusions: Elevated executive and psychosocial concerns are present in the patient population with sTOF. Although initial treatment strategy appears unrelated to neurodevelopmental outcomes, lower birth weight, genetic syndrome, and medical complexity and lower maternal education are risk factors. Early recognition of neurodevelopmental concerns can facilitate access to appropriate neurodevelopmental services in this high-risk group.

Keywords: congenital heart disease; executive functioning; neurodevelopment; psychosocial functioning; tetralogy of Fallot.