Postnatal Brain Trajectories and Maternal Intelligence Predict Childhood Outcomes in Complex CHD

Objective: To determine whether early structural brain trajectories predict early childhood neurodevelopmental deficits in complex CHD patients and to assess relative cumulative risk profiles of clinical, genetic, and demographic risk factors across early development. Study Design: Term neonates with complex CHDs were recruited at Texas Children’s Hospital from 2005–2011. Ninety-five participants underwent three structural MRI scans and three neurodevelopmental assessments. Brain region volumes and white matter tract fractional anisotropy and radial diffusivity were used to calculate trajectories: perioperative, postsurgical, and overall. Gross cognitive, language, and visuo-motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development and with the Wechsler Preschool and Primary Scale of Intelligence and Beery–Buktenica Developmental Test of Visual–Motor Integration. Multi-variable models incorporated risk factors. Results: Reduced overall period volumetric trajectories predicted poor language outcomes: brainstem ((β, 95% CI) 0.0977, 0.0382–0.1571; p = 0.0022) and white matter (0.0023, 0.0001–0.0046; p = 0.0397) at 5 years; brainstem (0.0711, 0.0157–0.1265; p = 0.0134) and deep grey matter (0.0085, 0.0011–0.0160; p = 0.0258) at 3 years. Maternal IQ was the strongest contributor to language variance, increasing from 37% at 1 year, 62% at 3 years, and 81% at 5 years. Genetic abnormality’s contribution to variance decreased from 41% at 1 year to 25% at 3 years and was insignificant at 5 years. Conclusion: Reduced postnatal subcortical–cerebral white matter trajectories predicted poor early childhood neurodevelopmental outcomes, despite high contribution of maternal IQ. Maternal IQ was cumulative over time, exceeding the influence of known cardiac and genetic factors in complex CHD, underscoring the importance of heritable and parent-based environmental factors

A-057 Deficits in Inhibitory Control Are Associated with Social and Emotional Difficulties Among Children with Congenital Heart Defects

Abstract Objective Research has suggested that children with congenital heart defects (CHD) may experience socioemotional maladjustment because of their often-seen executive dysfunction. However, preliminary work has largely used behavioral ratings of executive functioning. Our study used cognitive assessments of inhibitory control, an executive function key for emotional regulation and social initiative. Method We prospectively recruited 46 6-to-16 year olds with CHD (M = 11.65 years, SD = 3.11; 74% male) and 95 healthy controls (M = 12.09 years, SD = 2.87; 54% male). Children completed face-to-face and computerized tests of inhibitory control (D-KEFS Color-Word Interference Test; NIH Toolbox Flanker Inhibitory Control and Attention Test). Children and their parents also filled out scales assessing emotional and social functioning (Pediatric Quality of Life Inventory [PedsQL]; Harter Self Perception Profile [SPP]). Results Using regression, controlled for age, children with CHD had greater parent-rated emotional distress than healthy peers (p &amp;lt; .001). Poorer inhibition was associated with greater distress for children with CHD but not (or less so) healthy peers (p &amp;lt; .05). Children across groups rated their emotional functioning similarly; a face-to-face test of inhibition (but not a computerized test) was related with greater emotional health for both groups (p &amp;lt; .05). Children with CHD had poorer parent-rated social functioning than healthy peers on the PedsQL (p &amp;lt; .005) but not the SPP; there were no significant differences for self-reports. Inhibition was associated with social skills only in select models (p &amp;lt; .05). Conclusions Similar to past research, families reported more maladjustment than children. Regardless, poor inhibition emerged as one potential contributor to socioemotional maladjustment among children with CHD. Interventions targeting executive dysfunction may support socioemotional development. </jats:sec