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- Title
Stress Markers, Executive Functioning, and Resilience Among Early Adolescents With Complex Congenital Heart Disease.
- Authors
von Werdt, Lilian; Binz, Tina M.; O'Gorman, Ruth Tuura; Schmid, Alenka; Naef, Nadja; Rousson, Valentin; Kretschmar, Oliver; Liamlahi, Rabia; Latal, Bea; Ehrler, Melanie
- Abstract
Key Points: Question: Do early adolescents with complex congenital heart disease (cCHD) have higher stress markers than healthy controls, and is there an association with executive functions and resilience? Findings: In this case-control study of 100 early adolescents with cCHD and 104 controls, those with cCHD had higher stress markers in hair and lower executive function scores than those without cCHD. A significant interaction effect was observed between stress markers and executive function. Meaning: This study's results suggest evidence for clinically relevant alteration in physiological stress markers in adolescents with cCHD and an association with neurodevelopmental sequelae. This case-control study compares physiological stress markers, executive function, and resilience among individuals aged 10 to 15 years with complex congenital heart disease vs healthy controls. Importance: Infants with complex congenital heart disease (cCHD) may experience prolonged and severe stress when undergoing open heart surgery. However, little is known about long-term stress and its role in neurodevelopmental impairments in this population. Objective: To investigate potential differences between early adolescents aged 10 to 15 years with cCHD and healthy controls in physiological stress markers by hair analysis, executive function (EF) performance, and resilience. Design, Setting, and Participants: This single-center, population-based case-control study was conducted at the University Children's Hospital Zurich, Switzerland. Patients with different types of cCHD who underwent cardiopulmonary bypass surgery during the first year of life and who did not have a genetic disorder were included in a prospective cohort study between 2004 and 2012. A total of 178 patients were eligible for assessment at ages 10 to 15 years. A control group of healthy term-born individuals was cross-sectionally recruited. Data assessment was between 2019 and 2021. Statistical analysis was performed from January to April 2023. Exposure: Patients with cCHD who underwent infant open heart surgery. Main Outcomes and Measures: Physiological stress markers were quantified by summing cortisol and cortisone concentrations measured with liquid chromatography with tandem mass spectrometry in a 3-centimeter hair strand. EFs were assessed with a neuropsychological test battery to produce an age-adjusted EF summary score. Resilience was assessed with a standardized self-report questionnaire. Results: The study included 100 patients with cCHD and 104 controls between 10 and 15 years of age (mean [SD] age, 13.3 [1.3] years); 110 (53.9%) were male and 94 (46.1%) were female. When adjusting for age, sex, and parental education, patients had significantly higher sums of hair cortisol and cortisone concentrations (β, 0.28 [95% CI, 0.12 to 0.43]; P <.001) and lower EF scores (β, −0.36 [95% CI, −0.49 to −0.23]; P <.001) than controls. There was no group difference in self-reported resilience (β, −0.04 [95% CI, −0.23 to 0.12]; P =.63). A significant interaction effect between stress markers and EFs was found, indicating a stronger negative association in patients than controls (β, −0.65 [95% CI, −1.15 to −0.15]; P =.01). The contrast effects were not significant in patients (β, −0.21 [95% CI, −0.43 to −0.00]; P =.06) and controls (β, 0.09 [95% CI, −0.11 to 0.30]; P =.38). Conclusions and Relevance: This case-control study provides evidence for altered physiological stress levels in adolescents with cCHD and an association with poorer EF. These results suggest that future studies are needed to better understand the neurobiological mechanisms and timing of alterations in the stress system and its role in neurodevelopment.
- Subjects
SWITZERLAND; PHYSIOLOGICAL stress; EXECUTIVE function; BIOMARKERS; CORTISONE; CARDIAC surgery; STATISTICS; CONFIDENCE intervals; ACADEMIC medical centers; HAIR analysis; CROSS-sectional method; LIQUID chromatography-mass spectrometry; CONGENITAL heart disease; REGRESSION analysis; COMPARATIVE studies; T-test (Statistics); NEUROPSYCHOLOGICAL tests; RESEARCH funding; POPULATION-based case control; QUESTIONNAIRES; DESCRIPTIVE statistics; SCALE analysis (Psychology); DATA analysis; DATA analysis software; CARDIOPULMONARY bypass; PSYCHOLOGICAL resilience; LONGITUDINAL method; HYDROCORTISONE; CHILDREN; ADOLESCENCE
- Publication
JAMA Network Open, 2024, Vol 7, Issue 2, pe2355373
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.55373