Neurodevelopmental risk in a referred sample of hospitalized children with congenital heart disease: interrelation between communication and feeding vulnerabilities.

Abstract

Objective: To determine the prevalence of communication developmental risk in hospitalized children with Congenital Heart Disease (CHD) and to identify clinical, surgical, and hospitalization-related factors independently associated with increased risk.

Methods: This cross-sectional observational study was conducted at a tertiary pediatric cardiac center between September 2024 and April 2025. Sixty-five children referred for speech-language pathology assessment underwent communication development screening using a structured developmental observation protocol. Functional feeding status was assessed using the Pediatric Functional Oral Intake Scale. Multivariable logistic regression was used to identify factors independently associated with communication developmental risk, with Firth's penalized logistic regression performed as a sensitivity analysis given the low events-per-variable ratio.

Results: Twenty-five children (38%) were classified as being at risk for delayed communication development. Hospitalization in a ward setting, compared with intensive care, was independently associated with lower odds of risk classification (adjusted OR = 0.13, 95% CI 0.02‒0.77, p = 0.025), an association confirmed by the Firth sensitivity analysis (adjusted OR = 0.18, 95% CI 0.03‒0.80, p = 0.024). Length of hospital stay, cyanotic physiology, cardiopulmonary bypass duration, and aortic cross-clamp time were not independently associated with risk. Children classified as at risk also showed significantly greater feeding restrictions.

Conclusion: Communication developmental risk was common among hospitalized children with CHD. Hospitalization setting and feeding performance, rather than traditional markers of clinical severity, were associated with communication risk, suggesting a multifactorial model that integrates biological, functional, and environmental factors. These findings suggest that feeding function, alongside hospitalization setting, may help flag children at higher developmental risk before formal communication assessment is available. These exploratory findings support incorporating structured developmental surveillance into routine pediatric cardiac care.