Infant heart transplant may have down side

Children who were given a heart transplant in infancy score in the low-average range on tests of neurological development and IQ, according to a report in the Journal of Pediatrics.

However, these anomalies are not devastating.

"With comprehensive team care which emphasizes whole person care (physical, mental, social, emotional, spiritual) these children are able to have good quality of life with long-term success," Dr. Catherin Freier from Loma Linda University in California told AMN Health.

Freier and her colleagues assessed neuropsychological outcomes and their relationship to various factors in 55 heart-transplant children when they were an average of 6 years old.

The average IQ for these children was 81, the team reports, though almost one third of them had significant impairments in intelligence. Upon analysis, IQ was related to the number of serious infections children had experienced, their birth order, and their fathers' education level

Visual-motor function was also poorer with increasing number of serious infections, as well as with increasing total time spent in the hospital and longer time on a heart-lung machine.

"How sick the infant is post-transplant is very significant to long-term outcomes; thus, post-transplant care should be taken to minimize medical complications," Freier commented.

Neither parents nor teachers reported any tests of behavioral function in the abnormal range, the researchers note, but up to 20 percent of parents placed children in the at-risk range for a behavioral concern.

"We believe that these children will benefit from close monitoring of their cognitive performance and academic achievement to provide special education or resource services as soon as they are indicated," Freier concluded.

"Based on our experience," she added, "our care must be long-term, as this is a life-long condition and medical and psychological care often becomes even more important over time, as opposed to the first few years post-transplant."

SOURCE: Journal of Pediatrics, September 2004.