Neurodevelopmental outcomes at 2 and 4 years in children with congenital heart disease.

Background and ObjectivesChildren with congenital heart disease (CHD) are at risk for neurodevelopmental (ND) delays. The purpose of this study is to compare the ND testing results of children with CHD at 2 and 4years of age and determine if rates of ND delays change over time. MethodsChildren with CHD completed the Bayley Scales of Infant Development-III (BSID-III) at 2years of age, and standardized neuropsychological measures at 4years. Scores were compared with test norms and were classified as: average (within one SD of test mean); at risk (1-2 SDs from the test mean); and delayed (>2 SD from test mean). Pearson correlations and McNemar's exact tests were performed to determine the relationship between test scores at the two times of assessment. ResultsSixty-four patients completed evaluations at 243months of age and 4years of age. BSID-III cognitive and fine motor scores were correlated with preschool IQ and fine motor scores, r=.75 to .87, P<.0001. Agreement in score categories was 79% for cognitive and 61% for fine motor. More patients had at risk or delayed scores at age 4 vs age 2 (P.01). Conclusion(s)Despite significant correlations between 2- and 4-year-old test scores, many patients who scored in the average range at age 2 showed deficits at age 4. BSID-III scores at age 2 may underestimate delays. Therefore, longitudinal ND assessment is recommended.