Developmental outcomes and cognitive functioning in infant and child hearttransplant recipients

Pediatric heart transplantation has become a mainstay in the treatment of e nd-stage heart disease in infants and children. There is, however, sparse i nformation on post-transplant developmental and cognitive functioning. At L oma Linda University Children's Hospital 223 infants have undergone heart t ransplantation surgery with a survival rate of 73% (n = 165). This article reports on four areas of investigation of this cohort of infants. Infant de velopment: Two studies were done utilizing the Bayley Scales of Infant Deve lopment (mean 100, S.D. +/- 15). The first study (n = 48) showed mean value s within the normal range [Mental Development Index (MDI) 87; Psychomotor D evelopmental Index (PDI) 90]. The second study (n = 23) showed developmenta l scores within normal limits in 4-8 month olds with a tendency for decline in development at 12-24 months (MDI 83, PDI 77). Child development: Ninty- one infant recipients were greater than 5 years old. Forty-five children we re excluded because of long distances from the hospital, second transplanta tion, abnormal karyotype, primary language non-English, or invalid testing. The Wechsler Preschool and Primary Scale of Intelligence-Revised testing o f 5-6-year-olds (n = 23) showed a Full Scale IQ of 74, Performance IQ of 76 , and Verbal IQ of 77. The Wechsler Intelligence Scale for Children-III tes ting of 7-10-year-olds (n = 23) showed a Full Scale IQ of 86, Performance I Q of 89, and Verbal IQ of 86. The Wechsler Individual Achievement Test (mea n 100, S.D. +/- 15) yielded a Total Composite of 91, Mathematics Composite of 86, Language Composite of 98, and a Reading Composite of 94. Visual spat ial skills: Visual motor integration (mean 100, S.D. +/- 15) was evaluated in 5-10-year-olds with a mean of 87; however, 52% of the children had score s below 1 S.D. Subtests from the Wechsler scales that assess visual motor a nd visual spatial skills indicated significant deficits. Behavior: Younger children (n = 33) demonstrated behaviors indicative of social isolation. Ol der children (n = 36) showed behavior that was within the normal limits, bu t depression was noted in a significant number of them. Conclusions: Infant heart transplant recipients demonstrate IQ and achievement levels within t he normal range, but there is a significant amount of variability with more children than would be expected scoring in the lower ranges. Children with heart transplantation are at risk for visual spatial skill deficits. Young children are at risk for social isolation while symptoms of depression are noted in older children. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.