IMPACT OF CYANOSIS AND CHRONIC HYPOXIA ON NEURODEVELOPMENT IN CYANOTIC CONGENITAL HEART DISEASE

Objectives: Developmental delay and FTT are not uncommon in children with cyanotic- congenital heart disease (CHD). Although tissue hypoxia, loss of appetite and subsequent poor feeding can explain for growth retardation in these patients, however impact of cyanosis and chronic tissue hypoxia on neurodevelopment is not well defined.

Methods: A prospective study was designed to compare neurodevelopment in subjects with cyanotic and noncyanotic CHD.81 patients aged between 6 to 36 months (34 cyanotic and 47 noncyanotic) enrolled in this study from May 2002 to June 2003. Eligible cases didn't have any other underlying pathology such as perinatal or postnatal insults and chromosomal abnormality and had not undergone any corrective surgery during the study and follow up. Subjects were screened for any possible delay in either streams of development based on Modified Denver developmental scale (DDSII).

Results: 21(61.7%) of cyanotic cases and 8(17%) of noncyanotics had delay in one or more aspects of development. Delay in each stream in either groups were as follows, some patients had delay in more than one aspect. Eleven (32.4%) cyanotic patients vs. one (2.1%) in noncyanotic group had groß motor delay (P=0.0001). Fourteen (41.2%) cyanotic patients vs. seven (14.9%) in noncyanotics had delay in fine motor (P=0.007). Four (11.8%) cyanotic patients but none in non-cyanotic group had psychosocial delay (P=0.02). Thirteen (38.2%) cyanotic patients vs. three (6.4%) noncyanotics had speech delay (P=0.0003).

Conclusion: The above findings indicate possible effect of chronic hypoxia and cyanosis on neurodevelopment in children with cyanotic CHD, which may highlight the importance of early intervention in corrective surgery.