The Interplay of Interventions and Social Determinants of Health on Neurodevelopmental Outcomes in Children With Congenital Heart Disease.
BACKGROUND Neurodevelopmental disability is a chief concern of children with congenital heart disease longitudinally. Delays in cognition and language based on neurodevelopmental testing are known morbidities. Although it is known that school-age children often require special education (SPED) services, a closer look at this population correlating interventions and other environmental factors to developmental and school outcomes has not been explored. METHODS Demographic and clinical data were obtained on children who were seen in a cardiac developmental outcomes program, who underwent cardiac surgery in the first year of life, and who had neurodevelopmental testing using the Bayley Scales for Infant and Toddler Development, third edition, at 36 months or prior (n = 216). Receipt of therapies, daycare, educational programming, preschool, and SPED at school age were noted, as well as age at school entry. RESULTS Of 216 children with Bayley Scales for Infant and Toddler Development, third edition scoring, higher maternal education was associated with higher cognitive and language scores. Receipt of early childhood intervention (ECI) was associated with lower cognitive scores. Of the 216 children, 165 had documentation of whether SPED was or was not received. 55.8% of these children received SPED, with high Child Opportunity Index levels serving as a protective factor and ECI speech therapy and preschool SPED (ECSE) increasing the likelihood of receipt of SPED services. CONCLUSION Social determinants of health such as maternal education and neighborhood opportunity are key influencing factors on neurodevelopmental outcomes and receipt of SPED at school age when examining different sociodemographic factors and interventions.