Impact of early nutrition on cognitive outcomes in children with congenital heart disease: a longitudinal cohort study

Project Abstract

Early nutrition plays a pivotal role in neurodevelopment, particularly in vulnerable populations such as children with congenital heart disease (CHD), where perioperative stress, hypoxemia, and altered cerebral perfusion may compound risks for cognitive impairment. This longitudinal cohort study investigates the association between early nutritional status and later cognitive outcomes in children with CHD, spanning from birth to five years of age, to identify potential critical windows and modifiable factors. We enrolled 350 infants with CHD who underwent corrective or palliative surgery within the first year of life, and followed them at 6, 12, 24, 36, and 60 months. Nutritional exposure was operationalized through a composite Early Nutrition Index (ENI) incorporating birth weight adequacy, length-for-age z-score trajectories, caloric and protein intake during the first two years, exclusive breast-feeding duration, supplementation of iron and DHA, and incidence of feeding intolerance requiring fortification or parenteral nutrition. Cognitive outcomes were measured using age-appropriate standardized instruments Bayley Scales of Infant and Toddler Development (BSID-III) at 24 months, Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) at 48 months, and a neuropsychological battery at 60 months assessing language, executive function, attention, and visuospatial skills. We employed mixed-effects models to examine associations between ENI and cognitive scores over time, adjusting for confounders including CHD severity, surgical timing, ECMO exposure, perioperative complications, socioeconomic status, parental education, exposure to anesthesia, and postnatal growth indices. Mediation analyses explored whether growth trajectories and iron/DHA status mediated the nutrition-cognition relationship. Preliminary results indicate a positive, dose-responsive relationship between ENI and cognitive outcomes across time points, with higher ENI associated with greater BSID-III cognitive composite scores at 24 months and corresponding gains in WPPSI-IV full-scale IQ by 48 months. Iron and DHA adequacy emerged as key mediators, partially accounting for the observed associations, while growth velocity in the first two years augmented the effect size. Subgroup analyses revealed stronger associations in infants with more complex CHD and those requiring longer hospitalizations, suggesting amplified benefits of early optimized nutrition in higher-risk groups. Sensitivity analyses accounting for loss to follow-up and interim illnesses corroborated the robustness of the findings. These results underscore the importance of establishing proactive nutritional protocols for infants with CHD, including timely initiation of fortified feeds, targeted macronutrient provision, and micronutrient supplementation, in conjunction with standardized growth monitoring and early neurodevelopmental screening. The study highlights potential critical periods in the first two years of life during which nutritional optimization may yield substantial long-term cognitive dividends, informing multidisciplinary care pathways that integrate cardiology, nutrition, and developmental pediatrics to improve neurocognitive outcomes in this vulnerable population. Further randomized controlled trials are warranted to confirm causality and to delineate optimal ENI thresholds and component-specific effects on neurodevelopment in CHD.

Project Overview

What This Project Is About

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A plain-language overview of how early nutrition after birth might influence later thinking skills in children who have congenital heart disease, followed over several years to see long-term effects.

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The Problem It Addresses

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Many children with congenital heart disease (CHD) face growth and feeding challenges early in life. It is unclear how these early nutrition differences affect thinking and learning as they grow. This study looks for links between early diet quality and later cognitive development to guide care.

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Objectives of the Project

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1. Describe the nutritional patterns in the first year of life for children with CHD.
2. Assess cognitive outcomes at multiple ages using simple, child-friendly tests.
3. Explore whether early nutrition is associated with later thinking skills, after accounting for other factors.

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What You Will Do Step by Step

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Review relevant literature and design a plan, recruit participants, collect feeding data from medical records and parent interviews, administer age-appropriate cognitive assessments at set follow-up times, and analyze the relationship between early nutrition and cognitive scores using straightforward statistics. Ensure ethical approvals, manage data, and summarize findings for non-experts.

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Expected Outcome

We expect to find a link where better early nutrition relates to higher cognitive scores later, which could influence feeding guidelines and early intervention strategies for CHD patients.