Early developmental screening of children with single ventricle physiology may not identify future deficits

1. Neurodevelopmental screening at 14 months of age had poor positive predictive value of adaptive behavior deficits at age six years.

2. At six years of age, adaptive behavior skills in children with single ventricle physiology were significantly delayed compared to population norms.

Evidence Rating Level: 2 (Good)

Study Rundown: Despite improvement in survival rates of children born with single ventricle physiology, neurodevelopmental deficits are a common long term morbidity. This study sought to characterize these neurodevelopmental deficits by age and to examine whether early developmental scores at 14 months of age were predictive of outcomes at 6 years of age. Researchers found that a significant percentage of children who exhibited weakness in adaptive function skills at 6 years of age had not been identified as being at-risk during earlier developmental screening. Although developmental scores assigned to patients were based on parental subjective report, this study highlights the importance of ongoing developmental evaluations of children with single ventricle physiology to identify emerging deficits and thus facilitate timely therapeutic intervention.

Click to read the study in Pediatrics

Relevant Reading: Early developmental outcome in children with hypoplastic left heart and related anomalies

In Depth [retrospective cohort]: Parents were asked to complete the Bayley Scales of Infant Development, Second Edition at 14 months of age, and the Behavior Assessment System for Children, Second Edition (BASC-2) annually from ages 2 to 6 years. Children’s developmental deficit were categorized as either average (1 standard deviation`(SD) worse than the population mean), at risk (1-2 SDs below the mean), or impaired (2 SDs worse). 249 parents completed the BASC-2 at 6 years of age. Children with single ventricle physiology had significantly lower scores than the norm in adaptive skills, particularly as they grew older. At age three, 87% of children showed age appropriate adaptive skills, but, by six years of age, this number decreased to only 71%. Additionally, by age six, 22% of children were considered at risk in terms of their adaptive skills, and nearly 7% fell within the impaired range. Children with poor adaptive skills scores at the age of six years were more likely to have had delayed development at 14 months. However, 14-month developmental screening was unable to identify a substantial percentage of children who scored poorly at age 6 years, with a positive predictive value of 44% for the Mental Development Index and 36% for the Psychomotor Development Index.

Image: PD

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