The ICONIC study
Research type
Research Study
Full title
The Impact of congenital heart disease on neurodevelopment in childhood
IRAS ID
305016
Contact name
Serena Counsell
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
4 years, 1 months, 31 days
Research summary
Research Summary:
Congenital heart disease (CHD) describes heart problems that develop before birth, affecting almost 1 in 100 babies in the UK. Survival of infants with CHD has improved greatly over the past 50 years, due to advances in diagnostics and heart surgery. Despite this, children with CHD do worse at school, with up to half of children experiencing problems with movement, cognition, memory, hyperactivity, attention, speech and language skills. This presents a large and growing public health problem, whilst the underlying cause remains largely unknown.We will study 6-8 year old children who have CHD and healthy control children. The children will have a brain MRI and we will test their ability to perform a number of different tasks, which will highlight any problems they may have with cognition, attention, behaviour and how well they can interact with their families and other people. We undertook brain MRI scans when these children were babies and we will see how their brain development just after they were born is related to how well they perform on these tasks.
We will also investigate how parental stress and parenting styles are related to the children's outcome at 6-8 years as it may be possible to modify these factors to help to improve the children's outcome.
This study will improve our understanding of why brain development is altered in some children with CHD, explain why these children experience difficulties at school, and will enable us to identify those children who could benefit from interventions to improve outcome. Provision of effective interventions to protect brain health in these children at an early stage will help place vulnerable children onto healthy developmental trajectories, hence avoiding severe distress to children and their families and expense to society at large.Summary of Results:
Congenital heart disease (CHD) affects almost 1% of UK births and is the most frequent congenital malformation. Improvements in antenatal diagnosis, cardiac surgery, and perioperative care mean that most infants born with CHD now survive. However, children with CHD who required cardiopulmonary bypass surgery in infancy are at increased risk of problems in childhood and beyond, including problems in motor functions, mild impairments in executive function, attention and memory, difficulties with social interactions and emotional and behavioural problems. These may impact upon school achievement, employability and quality of life.We assessed outcomes in children with CHD and controls between 6-8 tears of age. Outcomes were assessed using standardised IQ measures and parent-rated measures of executive function. Children with CHD demonstrated increased risk of impairment in verbal comprehension and working memory. A more stimulating learning environment was associated with better verbal comprehension in both CHD and control groups, indicating a broader benefit of environmental factors on cognitive development. Additionally, processing speed was associated with emotional and cognitive regulation aspects of executive function in children with CHD only, suggesting altered neurocognitive relationships that may reflect underlying brain differences. When we looked at the relationship between brain MRI measures and outcome, we found brain growth from soon after birth to middle childhood was associated with IQ in middle childhood in children with CHD and controls.
REC name
Wales REC 5
REC reference
22/WA/0014
Date of REC Opinion
25 Jan 2022
REC opinion
Favourable Opinion