Unraveling the impact of child opportunity and medical factors on neuropsychological outcomes in school-age patients with critical congenital heart disease

We examine the role that medical history and social determinants of health play in predicting school-age intellectual (IQ) and executive functioning (EF) in children with critical congenital heart disease (cCHD). This is a retrospective observational study of 197 patients with cCHD (age 5-18 years) who attended a neuropsychological evaluation through the Cardiac Neurodevelopmental Program. Medical history and social determinants of health (SDOH), measured by the Childhood Opportunity Index (COI 3.0), were obtained via chart review. COI was a significant predictor of school-age IQ and EF. Seizure history and genetic condition were predictors of IQ; inclusion of COI improved the model, predicting an additional 14% of the variance. The Education subdomain of COI, reflecting neighborhood-level educational resources, drove this effect. Aortic obstruction and seizure history were significant predictors of parent-reported EF; inclusion of COI provided modest improvement. Only COI was identified as a predictor of performance-based EF. Social determinants of health are important predictors of school-age functioning in children with cCHD, and efforts to promote positive neurodevelopmental outcomes in this population must consider SDOH. IQ at school-age is related to neighborhood educational resources. This suggests that enhancing educational opportunities in patients with cCHD in lower-resourced communities may promote positive neurodevelopment and reduce disparities.