CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 148 AFRICA significantly associated with poorer language outcomes. Growth failure (p = 0.04) and DS (p < 0.001) were significantly associated with poorer motor outcomes. Prior to cardiac surgery, 13.3% (n = 4) of children without DS had motor delays, 7% (n = 2) had cognitive delays and 3.3% (n = 1) had language delays. Six children (20%) had developmental delays in one or more areas of development. In addition, a third (n = 10) of children were at risk for developmental delays (Table 3). In children with DS, prior to cardiac surgery, 70% (n = 7) had motor delays, 60% (n = 6) had cognitive delays and 40% (n = 4) had language delays. Nine children (90%) had developmental delays in one or more developmental area. Proportionally, significantly (p = 0.0001) more children with DS had developmental delays compared with children without DS (Tables 2, 3). Children scoring below one standard deviation of the test mean score (scores < 85) on Bayley-III met the criteria for referral to relevant rehabilitation therapies.6,41 Based on pre-operative developmental performance on the Bayley-III, 65% of the children (n = 26) qualified for referral to rehabilitation therapies, including all 10 children with DS (100%) and 16 without DS (53.3%). Proportionally, significantly more children with DS (p = 0.008) qualified for rehabilitation therapies compared with children without DS (Table 3). By six months post cardiac surgery, 22 children were still available for assessment, including 17 children without and five children with DS (Fig. 1). At six months post cardiac surgery, 11.8% (n = 2) of children without DS had motor delays, 5.8% (n = 1) cognitive and 11.8% (n = 2) language delays (Table 4). There was a slight decline in the prevalence of motor and cognitive delays post cardiac surgery, but an increase in language delays. Proportionally the number of children with developmental delays pre and post cardiac surgery was comparable. Two of the three (66.7%) children with developmental delays prior to cardiac surgery still presented with delays at six months post cardiac surgery. A comparable proportion of just over a third of children were still at risk of developmental delays (Table 5). By six months post cardiac surgery, 80% (n = 4) of children with DS had motor delays, 100% (n = 5) had cognitive delays and 80% (n = 4) had language delays (Table 4). Developmental deficits in children with DS became more pronounced post cardiac surgery, over time, and with increasing age across all developmental domains. Proportionally, the number of children with developmental delays pre and post cardiac surgery was comparable. All five children (100%) with developmental delays prior to cardiac surgery still presented with delays at six months post cardiac surgery. By six months post cardiac surgery, 68.2% of the children qualified for rehabilitation therapies (n = 15), including all five children with DS (100%) and 10 without DS (58.8%) (Table 4). The proportion of children without DS qualifying for rehabilitation therapies before and after cardiac surgery was Table 3. Pre-operative baseline developmental performance on the Bayley-III subscale Bayley-III subscale CHD with DS (n = 10) CHD without DS (n = 30) p-value Cognitive Median (range) Mean ± SD 60 (55–90) 65 ± 10.5 95 (55–130) 91.5 ± 16.5 0.0001*** Language Median (range) Mean ± SD 75.5 (62–112) 78.2 ± 15.2 94 (65–115) 94.5 ± 11.3 0.001** Motor Median (range) Mean ± SD 58 (46–88) 61 ± 14.1 86.5 (58–112) 85.7 ± 13.8 0.0001*** Children at risk for or presenting with developmental delays (n = 40) Cognitive, n (%) At risk Delayed 3 (30) 6 (60) 6 (20) 2 (7) 0.52 0.0004*** Language, n (%) At risk Delayed 4 (40) 4 (40) 3 (10) 1 (3.3) 0.03* 0.003** Motor, n (%) At risk Delayed 2 (20) 7 (70) 8 (26.7) 4 (13.3) 0.68 0.0006*** Number with delays in one or more areas of development, n (%) 9 (90) 6 (20) 0.0001*** Number considered to be at risk for developmental delays, n (%) 1 (10) 10 (33.3) 0.04* Children qualifying for referral to rehabilitation therapies (scores < 85) (n = 40) Cognitive, n (%) 9 (90) 8 (26.7) 0.0005*** Language, n (%) 8 (80) 4 (13.3) 0.0001*** Motor, n (%) 9 (90) 12 (40) 0.007** Number of children qualifying for rehabilitation therapies 10 (100) 16 (53.3) 0.008** Bayley-III subscale scores: < 70 delayed, 70–84 at risk and > 85 normal. Statistical significance: *p < 0.05, **p < 0.01, ***p < 0.001. Table 2. Child and family information Variables CHD without DS (n = 30) CHD with DS (n = 10) p-value Age of child at cardiac surgery (months) Median (range) 7.2 (1.4–20.9) 9.3 (3.3–20.3) 0.49 Mean ± SD 8.9 ± 5.5 10.3 ± 5.3 Gestational age (weeks) Median (range) 38 (31–41) 38 (32 – 40) 1.0 Mean ± SD 37.5 ± 2.02 37.5 ± 2.2 Birth weight (g) Median (range) 2795 (1690–3920) 2950 (1640–3950) 0.88 Mean ± SD 2870.3 ± 594.8 2904 ± 680.3 Growth status Median (range) –2.6 (–5.3–0.4) –2.6 (–4.0–0.5) 0.62 Mean ± SD –2.6 ± 1.5 –2.3 ± 1.6 Malnourished, n (%) 21 (70) 6 (60) 0.56 Type of CHD, n (%) Acyanotic 23 (76.7) 7 (70) 0.68 Cyanotic 7 (23.3) 3 (30) 0.68 Mean cardiac disease severity Moderate Moderate 1.0 Presence of hypotonia, n (%) Baseline 8 (26.7) 10 (100) 0.0001** Age of mother (years) Median (range) 27.5 (16–43) 37 (24–42) 0.04* Mean ± SD 27.6 ± 7.7 35.7 ± 6.1 Mean level of education Mother Grade 9–11 Grade 9–11 1.0 Father Grade 9–11 Grade 9–11 1.0 Parenting stress total score Median (range) 92.5 (40–99) 90 (5–99) 0.8 Mean ± SD 82.4 ± 20.9 84.3 ± 18.9 Clinically significant parenting stress, n (%) 7 (70) 17 (56.7) 0.46 Mean socio-economic status Lower class Lower class 1.0 CHD, congenital heart disease; WFA, weight for age. Sub-optimal growth: z-score < –2. Grade 9–11 equates to the lower to upper level of secondary education in the South African education system. Levels of significance: *p < 0.05, **p < 0.001.
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