Q & A with ENRRICH Trainee Tegan Turner on Language Abilities in Preschool Children with Critical Congenital Heart Disease (CHD)
Congenital heart disease (CHD) is the most common congenital defect. It occurs in about 8 out of 1000 live births1, with approximately 25% of these infants having critical congenital heart disease (cCHD)2 and requiring complex cardiac surgery early in life to survive. Advances in medical and surgical care have allowed us to change our focus from survival to consider neurodevelopmental outcomes such as motor performance, cognition, and language skills. Research has summarized motor and cognition outcomes among children with cCHD to better guide physicians and healthcare professionals manage these children. However, our understanding of language outcomes in children with cCHD was a considerable knowledge gap. We performed a systematic review and meta-analysis of the expressive (communication) language and receptive (comprehension) language in children with cCHD and compared their language outcomes to children without cCHD.
What inspired your work on critical CHD?
I had the privilege of completing a fieldwork term at the Rehabilitation Centre for Children in the prosthetics and orthotics department at the end of my undergraduate degree in kinesiology. During this time, I had the opportunity to hear Dr. Florencia Ricci speak about cerebral palsy and became interested in her work! When I had the opportunity to complete a summer research project in my first year of medical school, I recognized Dr. Ricci’s name in the potential projects and her project was unique in the realm of developmental pediatrics. I knew that being a part of her project was an opportunity I could not pass over. I found it a fascinating prospect to not only be able to learn about the niche world of cCHD, but also incredibly exciting that we could complete a systematic review and meta-analysis in language to help provide a piece of the puzzle in the neurodevelopmental outcomes of children with cCHD.
What approach did you take and what were the results?
I think research can seem overwhelming at first, especially when it involves synthesizing a lot of literature, like a systematic review and meta-analysis. Luckily for me, Dr. Ricci and Dr. Russell both have expansive knowledge in both cCHD and research methodology and were able to point me in the direction of sample articles, tools for learning about reviews, the Cochrane Collaboration, and of course readily providing their guidance throughout the entire project.
The beginning of the project consisted of me learning as much as I could about CHD and developmental outcomes that had been studied, as well as connecting with experts in the field of language (such as Dr. Cheung in clinical psychology and Shelley Proven in speech language pathology through The Specialized Services for Children and Youth Network (SSCY)! Next, we worked on our inclusion and exclusion criteria to make sure we were including the relevant articles and information. Finally, with the assistance of the University of Manitoba’s librarian, I was able to determine key terms for our search strategy and identify databases to find the relevant articles.
Once our search strategy was run, another reviewer and I completed a two-part screen in which we reviewed relevant titles and abstracts and then full texts. As this was a two-summer project, we re-completed the search strategy and screening of articles in the summer of 2021 to review for any new articles published in the last year.
We completed data extraction on 17 articles and as data permitted, we completed the meta-analysis portion for children ages 2-5 years. Findings of this systematic review and meta-analysis indicate that preschool children with cCHD have significantly lower expressive, receptive, and overall language abilities when compared to their peers. They also struggle more with expressive language skills than with receptive language skills.
What do you feel are the greater implications of your research?
Since language abilities explode at preschool age, knowing that we have data showing that children with cCHD are struggling at a key time in their development implies that we can target supports for these preschool age children and their families. With the right supports and interventions, there is opportunity for success as they go onto school age and beyond. As a medical student, the ability to have impact at a critical time in child development makes me incredibly excited for improving patient care!
Where do we go from here with critical CHD research?
I think my favorite part of this research was summarizing the results and information from each article, and realizing that the struggles in motor and cognition of children with cCHD also extend to language as well. Knowing broadly that children with cCHD struggle with language in their preschool years gives us opportunity to learn how to best intervene. Since environmental and social factors likely have a role to play in the language outcomes of children with cCHD, I think one avenue of future research might be to see how children in Manitoba fair in their language abilities compared to the rest of children with cCHD throughout Canada. This way, we might be able to even further tailor our supports to the children with cCHD in our province!
As an ENRRICH trainee, how has ENRRICH assisted you in reaching your professional/personal goals?
ENRRICH was incredibly supportive during my research, providing me the opportunity to meet with and hear from trainees in various areas and stages of their careers. They also gave me the opportunity to connect with fellow students to practice presentations and provided feedback to improve my knowledge translation. As I am hopeful that research will be a big part of my career, ENRRICH has allowed me to see the positive outcomes of longstanding researchers within the field of pediatrics and neuro-rehabilitation medicine. It is motivating to see the impact Manitoba trainees and researchers have had in the world of pediatrics and I am grateful for their continued support.
Lessons Learned
I learned a lot of things during this project. An important lesson that was reinforced was that consistent, clear documentation is essential to the success of a project. It can feel from one day to the next that progress is minimal, but the clear documentation really helped me to refocus each day and when writing my manuscript, to clearly articulate my process. I think being organized and clear are important in every career, but I know as a medical student this of utmost importance when communication with patients, their families, and the medical team, as well as thorough documentation of encounters.
I also learned that the process of synthesizing the research to inform practice can take quite a bit of time! There is a lot of detail-oriented parts to planning, completing and writing a systematic review and meta-analysis, so starting early, completing a bit every day, and keeping to a schedule is really important. Further, it’s always great to have a plan, but completing this research reminded me that there’s often a few bumps in the road (i.e. something takes longer than you think to complete or you have to go searching for more data to complete the set), and I appreciated the opportunity to consistently work on my critical thinking skills and adaptability.
References:
1. van der Linde D, Konings E, Slager M,etal .Birth prevalence of congenital heart disease worldwide a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.
2. Oster M, Lee K, Honein M, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Am Acad Pediatr 2013; 131: 1–15.
About the Author
Tegan Turner is a fourth year medical student at the University of Manitoba. She published her first article, Language abilities in preschool children with critical CHD: a systematic review in Cardiology in the Young in May of 2022 with her supervisors Dr. Florencia Ricci and Dr. Kelly Russell (also ENRRICH members!). This was part of the Bachelor of Science in Medicine degree two-year summer research project. In her spare time, she is national level track and field athlete and Special Olympics Coach. She is interested in a medical career in emergency medicine or physical medicine and rehabilitation, but regardless of where she ends up, she hopes a career in research and pediatric neurodevelopmental rehabilitation will be a part it!