Effects of Early Intervention on Educational Achievement of Children with Cyanotic Congenital Heart Disease after Neonatal Cardiac Surgery

Objectives: Univentricular heart physiology (UVHP) and transposition of the great arteries (TGA) are both cyanotic congenital heart defects (CHD) and require cardiac surgery during the neonatal period. In children with these CHDs, behavioral and neurocognitive difficulties, are common and might affect the further educational achievement. Early intervention can compensate existing deficits. Aim of the study was to evaluate the effect of early intervention on the educational achievement of patients with UVHP or TGA.

Methods: For this study, a subgroup analysis was conducted based on data collected in an exploratory online survey by the National Register for Congenital Heart Defects (NRCHD) in Germany in 2017. Of the participants considered in this analysis (n = 477), there were 173 (36.3%) patients diagnosed with TGA and 304 (63.7%) with UVHP. Early intervention was defined as speech therapy, physiotherapy, and/or occupational therapy on a regular basis before school enrolment.

Result: Overall, 298 of 477 (62.5%) of the patients received a form of early intervention before school enrolment. Among the patients with TGA and UVHP, 89 of 173 (51.4%) and 209 of 304 (68.8%) participants stated to have received early intervention, respectively. Of all patients receiving early intervention, twice as many had been diagnosed with UVHP as with TGA (UVH: n = 209/298; 70.1%; TGA: n = 89/298; 29.9%). Thus, patients with UVHP received significantly more often early intervention (χ ² test: p < 0.001). Among 123 patients with school-leaving qualifications at the time of data collection, we found a significantly higher level of upper secondary school degrees if these children had not received early intervention before school enrolment (χ ² test: p < 0.001). Overall, 20 of 63 (31.7%) patients with early intervention before school enrolment and 39 of 60 (65.0%) without early intervention before school enrolment completed the upper secondary education, respectively.

Conclusion: The results indicate that early intervention plays an important role among patients with severe CHD. Especially patients who are at risk for school problems and developmental disorders may benefit from early intervention, even though this cannot completely compensate any possible deficits. However, it must be taken into account that CHD patients at risk for developmental disorders might face even more academic challenges without early intervention. Therefore, we conclude that long-term follow-up examinations might be beneficial and further studies on the impact of early intervention are necessary.

Publication History

Article published online:
21 February 2021