Elevated Stress in Early Life Associated with Complex Congenital Heart Disease

Compared to healthy adolescents, early adolescents with complicated congenital heart disease (cCHD) experience higher levels of stress. Higher levels of cortisol and cortisone, which can negatively impact both brain structure and function, were seen in these kids.

“Alterations of the physiological stress system in patients with cCHD may drive neurodevelopmental impairments, particularly poorer [executive function] performance,” wrote authors in the paper.

To treat their condition, babies with congenital heart defects frequently have heart operations or other procedures. The youngster may experience increased and prolonged stress as a result, which may have an impact on their developing years. High levels of stress and cortisol have been linked in certain studies to a lower likelihood of decreased executive function (EF).

A single-center, population-based case-control study was carried out by the investigators to determine if cCHD affects physiological stress indicators, EF, and resilience in early adolescents (mean [SD] age, 13.3 [1.3] years]; 100 early adolescents with cCHD and 104 controls participated in the study.

The researchers used a neuropsychological test to assess EF, gathered hair samples to assess physiological stress markers (cortisol and cortisone concentration), and employed a standardized self-report questionnaire to assess resiliency.

Cortisol and cortisone concentrations in the hair revealed that patients with cCHD had considerably higher levels of stress than control patients, even after correcting for age and parental education (β, 0.28 [95% CI, 0.12 to 0.43]; P < .001). In comparison to controls, those with cCHD also showed low EF (β, −0.36 [95% CI, −0.49 to −0.23]; P < .001).

Additionally, stress and EF were negatively correlated, with the negative correlation being higher in cCHD patients than in controls (β, −0.65 [95% CI, −1.15 to −0.15]; P =.01). The current results demonstrated that, in contrast to children in good health, cCHD does not enhance patient resiliency, despite prior research suggesting a connection between resiliency and the disease. The authors do point out that a drop in EF, which is linked to stress and cCHD, may impair self-awareness and the capacity to assess resilience.

There were some limitations to the study. First off, it is unable to establish causation. Furthermore, there are confounding factors that affect the levels of cortisol and cortisone in the hair. Moreover, the resiliency questionnaire lacked comprehensiveness and there was no assessment of experienced psychological stress.

Talk about early-life interventions—like encouraging close parent-infant bonding, kangaroo care, breastfeeding, music therapy, and ICU-based trauma-informed care, to name a few—that may improve neurodevelopment outcomes in patients with cCHD. Early stress reduction is critical because stress raises cortisol levels, which may serve as a biomarker for neurodevelopmental consequences. Further investigation is required to assess this.

“Longitudinal studies are needed to better understand the neurobiological mechanisms and timing of alterations in the stress system and its role in neurodevelopmental outcomes in patients with cCHD,” the concluded.