| Objectives To examine the relation of the development of congenital heart disease(CHD)and the environmental risk factors, and to evaluate the cognitive function development outcome of children with CHD before they accept cardiac operation compared with their healthy peers(control).Methods The study was performed in Maanshan city Anhui province, for which had a high incidence area of congenital heart disease. A self-administered questionnaire was designed in the beginning and revised based on pilot study by author. Face-to-face structured interviews were carried out with the mothers of subjects by the doctors in Maanshan Maternal and Child Health care Service Centre. All the patients were born from Jan. 01, 2007 to Jun. 30, 2008. For each case, one controls were selected by same sex, same birthplace, and ages(±1 month). the case–control ratio was 1:1, 56 controls met the matching criteria in total. The questionnaire included social and demographic information (e.g., date of parents'birth, parents'education, family economic status), environmental exposure during preconception (e.g., noisy environment, toxic chemical substances, heavy metal, radiation exposure, high temperature and humidity vibration exposure), environmental exposure during gestation (e.g., taking medication during the first trimester, noisy environment, catching cold or fever during the first trimester ). 56 cases and 112 controls responded the questionnaire.For conditional Logistic regression data, we give the Wald P value. Differences were considered significant if P < 0.05. Data are presented odds ratios with 95% confidence intervals where appropriate. Conditional Logistic regression analyses were done using SPSS version 10.0. We analyzed the association of the environmental risk factors and CHD, atrial septal defect and ventricular septal defect.In the second study, a total of 84 cases were selected in Anhui children's hospital from Mar. 2008 to Nov. 2008, all of them were planning to accept cardiac operation. The cases of acyanotic congenital heart disease were 74, cyanotic type were 10. Considering the sex ratio and the distribution of age, we selected 84 healthy peers as controls. Patients with CHD and healthy controls were examined with a developmental neuropsychological assessment (Gesell development scale and Wechsler Intelligence Scale for Children). Their parents completed a behavioral questionnaire. The Gesell Development Diagnosis Scale test was used to evaluate cognitive development for children who were younger than 6 years old. The Gesell Development Diagnosis Scale has five subscales: adaptive behavior, gross motor, fine motor, language, and personal-social behavior. Through testing and interviewing, we can understand the level of children's maturity. Than, according to the existing score and the actual age, we calculated the development quotient (DQ) of the five subscales. For children who were older than 6years old, we used C-WISC to evaluate the verbal intelligent quotient (VIQ), performance intelligent quotient (PIQ) and full scale intelligent quotient (FIQ). Face-to-face structured interviews were carried out with the parents or other direct dependenters to acquire all children's development level. Student t-test or nonparametric test was performed to analyze the cognitive function collate changes of the two groups.Results The questionnaire revealed that the case and the control group with the same parents'education, family economic status, which suggest that the two groups have better comparability. The results showed that exposure to noisy environments half past year before pregnancy, taking hormone and catching a cold during the first trimester catching out were influencing the occurrence of CHD, With P values less than 0.05, OR values as 2.59,13.65,2.69respectively. Exposure to noisy environments half past year before pregnancy was influencing the occurrence of atrial septal defect, With P values less than 0.05, OR values as5.13. Exposure to heavy metal of husband half a year before gestation was influencing the occurrence of ventricular septal defect, With P values less than 0.05, OR values as 4.32.Overall, before cardiac surge, the cognitive function development level of children with congenital heart disease was in normal range. However, whose adaptive behavior, cross motor, fine motor, language and personal-social behavior DQ were worse than controls. With P values less than 0.05, t values as -8.52,-9.852,-4.62,-5.21,-8.52 respectively. The two groups have no significant difference in sex. Accordance with the age, cases with 0 years old were lower than contrals in DQ of adaptive behavior, cross motor, language and personal-social behavior. Cases with 0~3 years old were lower than contrals in DQ of adaptive behavior, cross motor, fine motor, language and personal-social behavior. Cases with more than 3 years old were lower than contrals in adaptive behaviors, cross motor, fine motor and personal-social behavior.Based on the triage type, severity of illness subgroup, children's DQ also varied. In 58 cases of ventricular septal defect, the DQ of 18 Serious were worse than the mild-to-moderate ones in adaptive behavior, cross motor, fine motor. With P values less than 0.05, t values as-3.70,-4.10,-2.74 respectively. Children who had tetralogy of Fallot were worse than the mild-to-moderate ventricular septal defect all the 5 fields. With P values less than 0.05, t values as-4.95,-7.45,-2.89,-3.51,-3.14 respectively. The tetralogy of Fallot group was worse than the serious ventricular septal defect group all over the 5 fields. With P values less than 0.05, t values as-1.50,-0.12,-0.98,-1.48,-0.48 respectively.The Social adaptive capacity of children with congenital heart disease was lower than the one of contrals within 2 years old. Z value is -4.04. Howere, there is no significant difference more than 2 years old.Conclusions Improving the health of parents, controlling or reducing the exposure of environmental risk factors seem to be the new idea for healthy pregnancy and healthy baby. Children with CHD have a risk of severe cognitive problems before they accept cardiac operation than that of children without any known heart failure. This suggests that primary health care providers should screen the cognitive competence in children with CHD at an early age to initiate therapeutic actions for children who show incipient cognitive problems.
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