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Gender differences in the developmental outcomes of children with congenital cardiac defects

Published online by Cambridge University Press:  25 January 2012

Annette Majnemer ,
Catherine Limperopoulos ,
Michael Shevell ,
Charles Rohlicek ,
Bernard Rosenblatt  and
Christo Tchervenkov
Annette Majnemer*
Affiliation:
School of Physical & Occupational Therapy, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada Department of Pediatrics, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada Departments of Neurology & Neurosurgery, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
Catherine Limperopoulos
Affiliation:
Division of Diagnostic Imaging & Radiology, George Washington University Medical Center, Children's National Medical Center, Washington, DC, United States of America
Michael Shevell
Affiliation:
Department of Pediatrics, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada Departments of Neurology & Neurosurgery, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
Charles Rohlicek
Affiliation:
Department of Pediatrics, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
Bernard Rosenblatt
Affiliation:
Department of Pediatrics, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada Departments of Neurology & Neurosurgery, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
Christo Tchervenkov
Affiliation:
Pediatric Cardiovascular Surgery, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
*
Correspondence to: Dr A. Majnemer, OT, PhD, School of Physical & Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec, Canada H3G 1Y5. Tel: +514 412 4400x22902; Fax: +514 412 4373; E-mail: [email protected]
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Abstract

Objective

This study compares the developmental and functional outcomes at school entry between boys and girls born with a congenital cardiac defect who required early surgical correction.

Study design

A prospective cohort of 94 children, including 49 percent boys, were followed up to 5 years of age and assessed for developmental progress. Developmental measures included Wechsler Preschool and Primary Scale of Intelligence – cognitive; Peabody Picture Vocabulary Test – receptive language; Peabody Developmental Motor Scale – motor; and Child Behaviour Checklist – behaviour. Measures of function included the Vineland Adaptive Behavior Scale and Functional Independence Measure for Children (WeeFIM).

Results

The mean scores of the boys on the WeeFIM subscales, such as self-care, mobility, cognition, were significantly lower than that of the girls. There was a trend for a greater proportion of boys to have abnormalities on neurological examination (boys 37.5 percent abnormal, girls 19.5 percent abnormal). Verbal, performance, and full scale Intellectual Quotients were 5–7 points lower in boys but did not reach significance (full scale Intellectual Quotient: boys 87.7 plus or minus 22.2; girls 93.9 plus or minus 19.3). Boys were more likely to have fine motor delays (50 percent, 82.7 plus or minus 16.5) compared with girls (28.2 percent, 87.0 plus or minus 15.8). There were no gender differences in receptive language or behavioural difficulties.

Conclusions

Boys born with congenital heart disease requiring early surgical repair appear to be at enhanced risk for neuromotor impairments and activity limitations. Findings support gender differences in the pathogenesis of early brain injury following hypoxic–ischaemic insults. This has implications for neuroprotective strategies to prevent brain injury.

Keywords

Malemotor delayintelligence quotientactivity limitations
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 5 , 13 September 2012 , pp. 514 - 519
Copyright
Copyright © Cambridge University Press 2012

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References

1.Ballweg, JA, Wernovsky, G, Gaynor, JW. Neurodevelopmental outcomes following congenital heart surgery. Pediatr Cardiol 2007; 28: 126–133.CrossRefGoogle ScholarPubMed
2.Majnemer, A, Limperopoulos, C, Shevell, MI, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. A new look at outcomes of infants with congenital heart disease. Pediatr Neurol 2009; 40: 197–204.CrossRefGoogle Scholar
3.Massaro, AN, El-Dib, M, Glass, P, Aly, H. Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev 2008; 30: 437–446.CrossRefGoogle ScholarPubMed
4.Alton, GY, Robertson, CM, Sauve, R, et al. Early childhood health, growth, and neurodevelopmental outcomes after complete repair of total anomalous pulmonary venous connection at 6 weeks or younger. J Thorac Cardiovasc Surg 2007; 133: 905–911.CrossRefGoogle ScholarPubMed
5.Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141: 51–58.CrossRefGoogle ScholarPubMed
6.Robertson, CM, Joffe, AR, Sauve, RS, et al. Outcomes from an interprovincial program of newborn open heart surgery. J Pediatr 2004; 144: 86–92.CrossRefGoogle ScholarPubMed
7.Wray, J. Intellectual development of infants, children and adolescents with congenital heart disease. Dev Sci 2006; 9: 368–378.CrossRefGoogle ScholarPubMed
8.Renolleau, S, Fau, S, Charriaut-Marlangue, C. Gender-related differences in apoptotic pathways after neonatal cerebral ischemia. Neuroscientist 2008; 14: 46–52.CrossRefGoogle ScholarPubMed
9.Johnston, MV, Hagberg, H. Sex and the pathogenesis of cerebral palsy. Dev Med Child Neurol 2007; 49: 74–78.CrossRefGoogle ScholarPubMed
10.McQuillen, P, Majnemer, A. Brain injury in newborns with congenital heart disease. In Miller S, Shevell M (eds.). Acquired Brain Injury in the Fetus and Newborn, International Review of Child Neurology Series. Wiley-Blackwell, London, England in press.Google Scholar
11.Azakie, A, Russell, IA. Gender differences in pediatric cardiac surgery: the surgeon's perspective. J Thorac Cardiovasc Surg 2004; 128: 4–6.CrossRefGoogle ScholarPubMed
12.Miller-Hance, WC, Tacy, TA. Gender differences in pediatric cardiac surgery: the cardiologist's perspective. J Thorac Cardiovasc Surg 2004; 128: 7–10.CrossRefGoogle ScholarPubMed
13.Mehta, R, Lee, KJ, Chaturvedi, R, Benson, L. Complications of pediatric cardiac catheterization: a review in the current era. Catheter Cardiovasc Interv 2008; 72: 278–285.CrossRefGoogle ScholarPubMed
14.Kao, CC, Chang, PC, Chiu, CW, Wu, LP, Tsai, JC. Physical activity levels of school-age children with congenital heart disease in Taiwan. Appl Nurs Res 2009; 22: 191–197.CrossRefGoogle ScholarPubMed
15.Paridon, SM, Mitchell, PD, Colan, SD, et al. A cross-sectional study of exercise performance during the first 2 decades of life after the Fontan operation. J Am Coll Cardiol 2008; 52: 99–107.CrossRefGoogle ScholarPubMed
16.Garcia, AW, Broda, MA, Frenn, M, Coviak, C, Pender, NJ, Ronis, DL. Gender and developmental differences in exercise beliefs among youth and predilection of their exercise behavior. J Sch Health 1995; 65: 213–219.CrossRefGoogle Scholar
17.Psychological Corporation. WPPSI-R: Wechsler Preschool and Primary Scale of Intelligence-Revised. Harcourt Brace Jovanovich, San Antonio, TX, 1989.Google Scholar
18.Folio, RM, Fewell, RR. Peabody Developmental Motor Scales and Activity Cards. DLM Teaching Resources, Austin, TX, 1983.Google Scholar
19.Dunn, LM. Peabody Picture Vocabulary Test, 3rd edn. American Guidance Service, Circle Pines, MN, 1997.Google Scholar
20.Achenbach, TM. Manual for the CBCL, 4-18 and 1991 Profile. Department of Psychiatry, University of Vermont, Burlington, VT, 1991.Google Scholar
21.Landgraf, J, Abetz, L, Ware, JE Jr. Child Health Questionnaire (CHQ): A User's Manual, 1st edn. The Health Institute, New England Medical Center, Boston, MA, 1996.Google Scholar
22.Abidin, RR. Parenting Stress Index (PSI), 3rd edn. Psychological Assessment Resources, Inc., Odessa, FL, 1990.Google Scholar
23.Sparrow, S, Balla, DA, Cicchetti, DV. Vineland Adaptive Behavior Scales, Interview Edition. Survey form Manual: A Revision of the Vineland Social Maturity Scale by EA Doll. American Guidance Service, Circle Pines, MN, 1984.Google Scholar
24.Uniform Data System for Medical Rehabilitation. WeeFIM System Clinical Guide, Version 5.01. University of Buffalo, Buffalo, NY, 1998.Google Scholar
25.Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Functional limitations in young children with congenital heart defects after cardiac surgery. Pediatrics 2001; 108: 1325–1331.CrossRefGoogle ScholarPubMed
26.Majnemer, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr 2008; 153: 55–60.CrossRefGoogle ScholarPubMed
27.Hurn, PD, Vannucci, SJ, Hagberg, H. Adult or perinatal brain injury: Does sex matter? Stroke 2005; 36: 193–195.CrossRefGoogle ScholarPubMed
28.Yager, JY, Wright, S, Armstrong, EA, Jahraus, CM, Saucier, DM. A new model for determining the influence of age and sex on functional recovery following hypoxic–ischemic brain damage. Dev Neurosci 2005; 27: 112–120.CrossRefGoogle ScholarPubMed
29.Mayoral, SR, Omar, G, Penn, AA. Sex differences in a hypoxia model of preterm brain damage. Pediatr Res 2009; 66: 248–253.CrossRefGoogle Scholar
30.Turtzo, LC, McCullough, LD. Sex differences in stroke. Cerebrovasc Dis 2008; 26: 462–474.CrossRefGoogle ScholarPubMed
31.Nijboer, CH, Groenendaal, F, Kavelaars, A, Hagber, HH, van Bel, F, Heijnen, CJ. Gender-specific neuroprotection by 2-iminobiotin after hypoxia–ischemia in the neonatal rat via a nitric oxide independent pathway. J Cereb Blood Flow Metab 2007; 27: 282–292.CrossRefGoogle Scholar
32.Fullerton, HJ, Wu, YW, Zhao, S, Johnston, SC. Risk of stroke in children: ethnic and gender disparities. Neurology 2003; 61: 189–194.CrossRefGoogle ScholarPubMed
33.Golomb, MR, Fullerton, HJ, Nowak-Gottl, U, deVeber, G, for the International Pediatric Stroke Study Group. Male predominance in childhood ischemic stroke: findings from the International Pediatric Stroke Study. Stroke 2008; 40: 52–57.CrossRefGoogle ScholarPubMed