Taking back-to-school to heart

Children born with a congenital heart malformation and requiring early open-heart surgery are at-risk for various types of developmental delays, according to an MUHC study.

Montreal, 15 September 2008 - With a new environment, new friends and new activities, the first day of school is a big step in the lives of young school-age children and one that requires all their cognitive, motor and social-emotional skills. This challenge is even greater for those born with a congenital heart malformation and who underwent open-heart surgery soon after birth. In her latest study, Dr. Annette Majnemer, from the Research Institute of The Montreal Children’s Hospital at the MUHC, has assessed the developmental difficulties in these children and provided keys for possible prevention. Her article was recently published in The Journal of Pediatrics.

“Our results show that these young ‘survivors’ of heart surgery at birth are more likely to have difficulties in school,” Dr. Majnemer explained. “These difficulties can be linked to their learning abilities, as the average IQ of the surveyed patients was average or low, with 22% having an IQ below 80. Also, 27% of these children experience behaviour problems that often lead to challenges in social development and, later, with lower self-esteem.”

The patients involved in this study were tested at birth and early infancy, at 18 months and at five years. A careful assessment before surgery revealed nervous system anomalies in more than 50% of the newborns who were to have open-heart surgery soon after birth, as well as in over a third of the infants who were to have it a bit later in life. It is therefore very probable that the heart malformation is associated with a lack of adequate oxygen supply to the brain early in life, or even before birth, which hampers the child's development independent of the surgery. This would also explain the researchers’ clear finding that the older the child at the time of the operation, the lower his or her IQ.

“We need to understand the mechanisms that cause this delay in cognitive development as well as other developmental domains in children born with a congenital heart malformation,” Dr. Majnemer stated. “This will give us a case to promote early intervention and therefore help prevent or minimize developmental delays in a number of children. It will also give families access to better quality information to help them make informed choices about services needed and enable them to better monitor their children.”

Monitoring the global development of children who have undergone this surgical procedure has not yet been established as standard health practice in Canada. However, a developmental  surveillance program is in place at the Montreal Children's Hospital for newborns diagnosed there. “We hope that this study will be a first step towards generally implementing developmental screening and timely referral to rehabilitation and educational specialists if needed, as this is a common request from the families of patients,” Dr. Majnemer recommended.

Dr. Annette Majnemer is a researcher in the Health Outcomes Axis and the Human Reproduction and Development Axis at the Research Institute of the Montreal Children’s Hospital at the McGill University Health Centre (RI MUHC). She is also a Professor at the School of Physical and Occupational Therapy at the Faculty of Medicine as well as an Associate Member of the Departments of Pediatrics and Neurology and Neurosurgery at McGill University. Research on this and other childhood disability issues by MUHC and other Quebec-based investigators may be found on a new bilingual website : www.childhooddisability.ca .

This longitudinal study was financed by the March of Dimes (USA), the Heart and Stroke Foundation, and the National Health Research and Development Program of Health Canada.

Find this press release, with the original article and a short audio document by following this link : http://www.muhc.ca/media/news/.

The Montreal Children’s Hospital (MCH) is the pediatric teaching hospital of the McGill University Health Centre and is affiliated with McGill University. The MCH is a leader in providing a broad spectrum of highly specialized care to newborns, children, and adolescents from across Quebec. Our areas of medical expertise include programs in brain development/behaviour, cardiovascular sciences, critical care, medical genetics and oncology, tertiary medical and surgical services, and trauma care. Fully bilingual, the hospital also promotes multiculturalism and serves an increasingly diverse community in more than 50 languages. The Montreal Children’s Hospital sets itself apart with its team approach to innovative patient care. Our health professionals and staff are dedicated to ensuring children and their families receive exceptional health care in a friendly and supportive environment.

The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health-care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, the university health center affiliated with the Faculty of Medicine at McGill University. The institute supports over 600 researchers, nearly 1200 graduate and post-doctoral students and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge.
The Research Institute of the MUHC is supported in part by the Fonds de la recherche en santé du Québec.

For more information please contact:

Isabelle Kling
Communications Coordinator (research)
MUHC Public Relations and Communications
514 843 1560

Lisa Dutton
Public Relations and Communications
The Montreal Children’s Hospital of the MUHC