Early school-age cognitive performance post-pediatric heart transplantation

Analysis of UNOS: Longitudinal Cognitive and Motor Delay After Pediatric Heart Transplantation and Associated Survival

BACKGROUND

We investigated factors associated with the longitudinal presence of neurodevelopmental delays in pediatric heart transplant recipients.

METHODS

The United Network for Organ Sharing Registry was queried for patients aged <18 years who received a first-time isolated heart transplant between March 2008 and December 2022. Two patient cohorts were developed, those with and without (1) definitive motor delay (MD) and (2) definitive cognitive delay (CD).

RESULTS

The MD cohort was comprised of 3847 patients (n = 3267 [no MD], n = 580 [definitive MD]) and the CD cohort was comprised of 3446 patients (n = 2689 [no CD], n = 757 [definitive CD]). The MD cohort and the CD cohort shared 3189 patients. Compared with the intracohort nondelayed patients, definitive MD and CD cohorts each independently had higher rates of congenital heart disease, ventilator support at transplant, and stroke before discharge (P < .001 for all). Patients with a definitive delay at follow-up had worse longitudinal survival, with hazard ratios of 2.82 (95% CI, 2.32-3.44; P < .001) for the MD cohort and 1.67 (95% CI, 1.32-2.05; P < .001) for the CD cohort. Stroke before discharge and symptomatic cerebrovascular disease at listing were both predictors of CD and MD at follow-up. The definitive MD and CD cohorts each independently had higher rates of stroke before discharge (MD cohort, 57 of 580 [9.8%] vs 48 of 3267 [1.5%]; CD cohort, 53 of 757 [7.0%] vs 42 of 2689 [1.6%]; P < .001 for both), and symptomatic cerebrovascular disease at listing was a predictor of CD (odds ratio, 4.16; 95% CI, 2.62-6.58) and MD (odds ratio, 3.30; 95% CI, 2.06-5.22) at follow-up.

CONCLUSIONS

Patients with MD and/or CD after receiving a heart transplant share several characteristics, including increased stroke before discharge, and have decreased longitudinal survival compared with their nondelayed counterparts.

Pediatric Organ Transplantation and Learning Disabilities: A Systematic Review

OBJECTIVES

Organ transplant is a vital treatment for pediatric patients. Kidney, liver, heart, and other organ transplants can significantly improve the quality of life for children with various chronic diseases and can improve long-term survival rates. However, the effects of transplant on cognitive and educational aspects should be considered, including the effects of pre- and posttransplant treatment protocols, medications, psychosocial stress, and surgical interventions. Learning disabilities can negatively affect the child's educational life, social relationships, and overall quality of life. We aimed to examine the prevalence of learning difficulties after organ transplant, the influencing factors, and the interventions aimed at solving these problems by conducting a systematic review of existing research on learning difficulties associated with pediatric organ transplant.

MATERIALS AND METHODS

For this systematic review, We searched PubMed, Cochrane, Web of Science, Science Direct, and Scopus databases to examine studies conducted during the past decade. We used the key words organ transplantation, pediatrics, and learning disabilities for our search. We included English language, full-text articles in the study; meta-analyses, systematic reviews, and case reports for which the full text was not available in English were excluded from the study.

RESULTS

Among an initial search result of 174 articles, 4 met the inclusion criteria. Across all studies, a consistent observation emerged that indicated a decline in neurocognitive functions among children who had undergone organ transplant. Specific areas affected included verbal intelligence, memory, reading/spelling skills, mathematical ability, motor skills, attention, and memory, collectively contributing to learning difficulties.

CONCLUSIONS

In light of the findings, minimizing learning difficulties in children after organ transplant necessitates strategies such as reducing transplant waiting times, seamlessly integrating children into the posttransplant school environment, and implementing specialized programs within educational institutions.

Cognitive outcome and its neural correlates after cardiorespiratory arrest in childhood

Hypoxia-ischaemia (HI) can result in structural brain abnormalities, which in turn can lead to behavioural deficits in various cognitive and motor domains, in both adult and paediatric populations. Cardiorespiratory arrest (CA) is a major cause of hypoxia-ischaemia in adults, but it is relatively rare in infants and children. While the effects of adult CA on brain and cognition have been widely studied, to date, there are no studies examining the neurodevelopmental outcome of children who suffered CA early in life. Here, we studied the long-term outcome of 28 children who suffered early CA (i.e., before age 16). They were compared to a group of control participants (n = 28) matched for age, sex and socio-economic status. The patient group had impairments in the domains of memory, language and academic attainment (measured using standardised tests). Individual scores within the impaired range were most commonly found within the memory domain (79%), followed by academic attainment (50%), and language (36%). The patient group also had reduced whole brain grey matter volume, and reduced volume and fractional anisotropy of the white matter. In addition, lower performance on memory tests was correlated with bilaterally reduced volume of the hippocampi, thalami, and striatum, while lower attainment scores were correlated with bilateral reduction of fractional anisotropy in the superior cerebellar peduncle, the main output tract of the cerebellum. We conclude that patients who suffered early CA are at risk of developing specific cognitive deficits associated with structural brain abnormalities. RESEARCH HIGHLIGHTS: Our data shed light on the long-term outcome and associated neural mechanisms after paediatric hypoxia-ischaemia as a result of cardiorespiratory arrest. Patients had impaired scores on memory, language and academic attainment. Memory impairments were associated with smaller hippocampi, thalami, and striatum. Lower academic attainment correlated with reduced fractional anisotropy of the superior cerebellar peduncle.

Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) - the TransplantKIDS mental health project

The present article describes the protocol of a mixed-methods study (an observational cohort design and focus groups), aimed to examine neuropsychological functioning and other biopsychosocial outcomes, therapeutic adherence and unmet care needs in paediatric population undergoing solid organ or allogeneic hematopoietic transplant during the pre- and post-transplant phases. Following a multi-method/multi-source approach, neuropsychological domains will be comprehensively measured with objective tests (SDMT, K-CPT 2/CPT 3, TAVECI/TAVEC, WISC-V/WAIS-IV Vocabulary and Digit Span subtests, Verbal Fluency tests, Stroop, ROCF, and TONI-4); ecological executive functioning, affective and behavioral domains, pain intensity/interference, sleep quality and therapeutic adherence will be assessed through questionnaires (parent/legal guardians-reported: BRIEF-2 and BASC-3; and self-reported: BASC-3, BPI, PROMIS, AIQ and SMAQ); and blood levels of prescribed drugs will be taken from each patient's medical history. These outcomes will be measured at pre-transplant and at 4-weeks and 6-months post-transplant phases. The estimated sample size was 60 patients (any type of transplant, solid organ, or hematopoietic) from La Paz University Hospital (Madrid, Spain). Finally, three focus group sessions will be organized with patients, parents/guardians, and transplant clinicians (n = 15, with 5 participants per group), in order to qualitatively identify unmet care needs during the pre-, and post-transplant stages of the process. The study protocol was registered at ClinicalTrials.gov (NCT05441436).

Allied health and nursing practices in pediatric solid organ transplantation: An international survey

INTRODUCTION

With improved survival in pediatric solid organ transplantation (SOT) care has focused on optimizing functional, developmental, and psychosocial outcomes, roles often supported by Allied Health and Nursing professionals (AHNP). However, there is a scarcity of research examining frameworks of clinical practice.

METHODS

The International Pediatric Transplant Association AHNP Committee developed and disseminated an online survey to transplant centers as a quality improvement project to explore AHNP practice issues. Participant responses were characterized using descriptive statistics, and free-text comments were thematically analyzed. Responses were compared across professional groups; Group 1: Advanced Practice Providers, Group 2: Nursing, Group 3: Allied Health.

RESULTS

The survey was completed by 119 AHNP from across the globe, with responses predominantly (78%) from North America. Half of respondents had been working in pediatric transplant for 11+ years. Two-thirds of respondents were formally funded to provide transplant care; however, of these not funded, over half (57%) were allied health, compared to just 6% of advance practice providers. Advanced practice/nursing groups typically provided care to one organ program, with allied health providing care for multiple organ programs. Resource constraints were barriers to practice across all groups and countries.

CONCLUSION

In this preliminary survey exploring AHNP roles, professionals provided a range of specialized clinical care. Challenges to practice were funding and breadth of care, highlighting the need for additional resources, alongside the development of clinical practice guidelines for defining, and supporting the role of AHNP within pediatric SOT. Professional organizations, such as IPTA, can offer professional advocacy.

Quality of life and psychosocial outcomes of adults who were pediatric solid organ transplant recipients: A systematic review

BACKGROUND

The number of pediatric SOT recipients surviving into adulthood is increasing. Thus, understanding their psychosocial and QoL outcomes is important. We conducted a systematic review to collate existing literature examining QoL outcomes (physical functioning, psychological functioning, social functioning), as well as risk and protective factors associated with QoL, among adults who underwent SOT during childhood.

METHODS

A systematic search of five databases, from inception to January 6, 2021, was conducted to identify articles that reported on QoL outcomes for adults (≥18-year of age) who received a SOT during childhood (<19-year of age).

RESULTS

Twenty-five articles met inclusion criteria. Studies examined QoL across a range of SOT populations (liver, kidney, heart). QoL and psychosocial outcomes were variable; however, the majority of studies indicated QoL in this population to be similar to the general population, or at least similar to other chronic illness groups, with the exception of physical and social functioning. Factors related to a more optimal medical course, younger age at transplant and follow-up, and positive psychosocial functioning, were found to be predictive of better QoL outcomes.

CONCLUSIONS

While several studies indicated QoL to be similar to the general population, the literature is limited in both quantity and quality. No study employed prospective, longitudinal methodologies to systematically evaluate QoL over time and few studies utilized normative-based measures of QoL. Furthermore, several SOT groups were under-represented in the literature (e.g., lung, intestine, multi-visceral). Nonetheless, findings have implications for intervention and clinical decision-making.

Neurocognitive Deficits and Sequelae Following Severe hand, foot, and mouth disease from 2009 to 2017, in JiangSu Province, China: A Long-Term Follow-Up Study

BACKGROUND

To evaluate the long-term sequela and cognitive profile resulting from severe hand, foot and mouth disease (HFMD) with central nervous system (CNS) involvement.

METHODS

Two-hundred-and-ninety-four HFMD cases were included in a retrospective follow-up study. Physical examination were conducted. The Chinese Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was used to assess intelligence.

RESULTS

Fifty-eight mild HFMD cases and 99 severe HFMD cases with mild CNS involvement did not present any neurological sequelae. While the sequelae incidence of severe HFMD with more severe CNS complications were 50.0%. The proportion of full scale intelligence quotient (FSIQ) impairment was 45.0%. In the 2:6-3:11 age group, severe HFMD with more severe CNS complications and lower maternal education level were risk factors for verbal comprehension disorder. Urban-rural residence and lower paternal education level were risk factors for FSIQ disorder. Furthermore, in the 4:0-6:11 age group, severe HFMD with more severe CNS complication was a risk factor for visual spatial disorder and fluid reasoning disorder. Lower paternal education level was a risk factor for FSIQ disorder.

CONCLUSION

Early assessment and intervention among severe HFMD patients with more severe CNS involvement at a very young age will prove beneficial for their future performance.