A baby's head circumference provides information about the possible presence of microcephaly., iStockphoto.com | thodonal © iStockphoto.com | thodonal

Medicine and Healthcare

Microcephaly – a Risk?

Many heart children need targeted support

Scientific name of the study

Microcephaly is associated with impaired educational development in children with congenital heart disease

Heart children usually keep up well at school. Many of them even graduate from high school. "This is due not least to targeted support, which can compensate for a number of things, including when operations and rehab stays make it difficult for children to attend school continuously," says Constanze Pfitzer, a physician at the German Heart Institute in Berlin. However, the challenges are even different for children with impaired body growth and too small a head circumference, also known as microcephaly. This is shown by the results of a first study under her leadership, which examined the academic development of affected children.

Severe Congenital Heart Defects Favor Microcephaly

For the scientific analysis of the relationship between microcephaly and school career, the research team led by Constanze Pfitzer was able to draw on the cohort of the PAN-KU study at the Competence Network for Congenital Heart Defects from the National Registry for Congenital Heart Defects, which followed the large PAN study. "Most studies examining children's physical development focus on body weight and body length. The PAN-KU study at the Competence Network for Congenital Heart Defects is one of the first comprehensive studies that also took into account head circumference, which is important for assessing neurological development," explains Constanze Pfitzer. Her new study shows that microcephaly, which is primarily associated with severe congenital heart defects, can have a major impact on the educational development of children and adolescents.

  • Good to know

    Severity of Congenital Heart Defect Is a Factor

    Microcephaly is strikingly associated with the severity of the congenital heart defect. Nearly one-third (30.8 percent) of microcephalic patients had severe congenital heart defects associated with other organ malformations. By comparison, among children who did not have microcephaly, the rate of complex congenital heart defects was significantly lower, totaling 16.6 percent.

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Mental Illness More Than Twice as Common

One in eight children with a congenital heart defect from the comprehensive PAN-KU cohort is affected by microcephaly. The fact that the head malformation can be accompanied by developmental delays and cognitive impairments is also confirmed by the study of the research team led by Constanze Pfitzer. "What was striking was that, compared to children with congenital heart defects without microcephaly, those affected were more than twice as likely to be receiving treatment for attention deficit disorder, depression, anxiety disorder, learning disorder or speech disorder," says the aspiring pediatric cardiologist. Sixty-seven percent of microcephaly patients suffered from such concomitant disorders, compared with 29.8 percent of children without the head malformation.

Significant Differences in Support and School Career

A survey linked to the study showed that the vast majority of children with a head malformation (85.7 percent) received targeted developmental support at an early age, while this was the case for less than half of the children without microcephaly (47.6 percent). Both groups started school at around six years of age. At 89.9 percent, most of the children without microcephaly started in a regular elementary school. In contrast, only slightly more than half (51.6 percent) of the children with this disorder started school.

14.3 Percent Attend a Grammar School

The picture is similar for secondary schools. In comparison, only half as many children with microcephaly (14.3 percent) attend a grammar school, while their proportion at special schools was eight times higher. More than half of the children (52.7 percent) took advantage of supportive measures, such as special learning difficulties. For students without microcephaly, this was only slightly more than one-fifth (21.6 percent).

Hardly any Differences in School Grades

In terms of their academic performance, children with and without microcephaly do about equally well. Children with microcephaly also did not differ significantly in the number of class repetitions from their peers without this malformation. The period of absence from school was no more than one month for most children with microcephaly (82 percent). In this sample, the educational level of the parents had no discernible influence on the types of primary and secondary school attended, the frequency of repeating a grade, or the use of remedial measures.

Intensive Further Research Needed

"Microcephaly shows an increased risk of impaired school development overall. At the same time, we have quite encouraging results with regard to school performance," Constanze Pfitzer classifies. "Which physical mechanisms are behind the clinically identified developmental delays is still under investigation. It is assumed that prenatal impairments of the blood circulation and a genetic link between heart and brain development are important reasons. At the same time, more intensive research is needed on other causes."

Expand Routine Screening, Promote Individual Abilities

The scientists recommend including measurement of head circumference in routine examinations of infants and children with congenital heart defects so that more targeted intervention and support can be provided in the event of microcephaly. "In our performance-oriented society, it is often made difficult for people with cognitive impairments to develop their individual abilities as self-determinedly as possible and at their own pace," observes Ulrike Bauer, executive director of the National Registry and the Competence Network for Congenital Heart Defects. This makes it all the more important to make the diagnosis early on, she says. "Parents should be specifically enabled and encouraged as early as possible to pay attention to and respond to their children's special abilities. Especially when it comes to choosing a school and support programs, the individual talents and questions of the children should be considered first and foremost," advises Ulrike Bauer.

  • Wissenschaftliche Details zur Studie

    A baby's head circumference provides information about the possible presence of microcephaly. © iStockphoto.com | thodonal
    A baby's head circumference provides information about the possible presence of microcephaly.

    Erfahren Sie mehr zum Studiendesign, den Materialien und Methoden, sowie zu den Hintergründen der Studie.

    Learn more about the study design, material and methods, as well as the background of the study:

    Publications

    • 6.10.2022

      Microcephaly is associated with impaired educational development in children with congenital heart disease.

      Pfitzer C, Sievers LK, Hütter A, Khaliq HA, Poryo M, Berger F, Bauer UMM, Helm PC, Schmitt KRL

      Frontiers in cardiovascular medicine 9, 917507, (2022). Show this publication on PubMed.


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