Microcephaly is associated with impaired educational development in children with congenital heart disease

Abstract

Objectives: This study aims to evaluate the school careers of patients with congenital heart disease (CHD) and microcephaly.

Methods: An exploratory online survey was conducted on patients from a previous study on somatic development in children with CHD in 2018 (n = 2818). A total of 750 patients participated in the online survey (26.6%). This publication focuses on 91 patients (12.1%) diagnosed with CHD and microcephaly who participated in the new online survey.

Results: Microcephaly was significantly associated with CHD severity (p < 0.001). Microcephalic patients suffered from psychiatric comorbidity two times as often (67.0%) as non-microcephalic patients (29.8%). In particular, the percentage of patients with developmental delay, intellectual debility, social disability, learning disorder, or language disorder was significantly increased in microcephalic CHD patients (p < 0.001). A total of 85.7% of microcephalic patients and 47.6% of non-microcephalic patients received early interventions to foster their development. The school enrollment of both groups was similar at approximately six years of age. However, 89.9% of non-microcephalic but only 51.6% of microcephalic patients were enrolled in a regular elementary school. Regarding secondary school, only half as many microcephalic patients (14.3%) went to grammar school, while the proportion of pupils at special schools was eight times higher. Supportive interventions, e.g., for specific learning disabilities, were used by 52.7% of microcephalic patients and 21.6% of non-microcephalic patients.

Conclusion: Patients with CHD and microcephaly are at high risk for impaired educational development. Early identification should alert clinicians to provide targeted interventions to optimize the developmental potential.

Keywords: congenital heart disease; development; education; microcephaly; school; supportive interventions.

Figure 1

Mean head circumference in CHD patients. Head circumference percentiles at 3–4 months in all CHD patients and subgroups. The gray circle represents the 50 percentile, and data of patients and subgroups are denoted as the mean. SD for all, sex and simple severity are 33, moderate severity 32, and complex 31.

Figure 2

Prevalence of microcephaly in patients with simple, moderate, or complex CHD. The pie chart denotes the raw n of patients defined by CHD severity classification and head circumference. Only patients with known CHD severity scores and known head circumference are included (n = 707).

Figure 3

Psychiatric comorbidity in microcephalic CHD patients. The chart visualizes the percentage of patients with the most prevalent psychiatric disorders among microcephalic or non-microcephalic patients; * denotes a significant difference compared to non-microcephalic, p < 0.001, and + denotes p < 0.05.

Figure 4

Educational development in CHD patients. The graph visualizes the school career of CHD patients with or without microcephaly. The median age of school enrollment and the first change of school are given in the figures. The distribution of different kinds of primary schools in the left pie chart is represented, and the pie chart on the right represents the different kinds of secondary schools. Further, the usage of early and/ or specific interventions to support the school careers is given. Differences in the kind of school are significant < 0.001; additionally * denotes a significant difference compared to non-microcephalic patients, p < 0.001, and + denotes p < 0.05.