Background/Objectives: Congenital heart disease (CHD) is associated with altered brain development and an increased risk of neurodevelopmental difficulties, particularly in more severe forms of the condition. Although alterations in functional brain connectivity have been reported before and after the first corrective surgery in early infancy, as well as in adulthood, little is known about their presentation in early childhood and their association with neurodevelopmental outcomes. This study aimed to characterize resting-state functional connectivity in 3-year-old children with moderate-to-severe CHD and to examine its associations with neurodevelopmental outcomes, including cognitive, language, and motor abilities. Methods: Twenty-five 3-year-old children with moderate-to-severe CHD and 28 age-matched healthy controls completed resting-state functional near-infrared spectroscopy (fNIRS) analysis and a standardized neurodevelopmental assessment. Connectivity was compared across networks using a repeated-measures analysis of covariance (ANCOVA), then within each network separately, controlling for maternal socioeconomic status and with sex as a factor. Associations with neurodevelopmental measures were examined using hierarchical linear regressions adjusted for group, sex, and socioeconomic status, with connectivity-by-group interactions tested. Results: Children with moderate-to-severe CHD showed lower resting-state functional connectivity than controls specifically within the right fronto-temporal network, with no group differences in the four remaining networks, as well as poorer language performance. Greater inter-hemispheric functional connectivity was associated with fewer executive function difficulties and better overall motor performance across participants, and greater frontal connectivity with better motor coordination, with no significant differences in these associations between groups. Conclusions: Preschool-aged children with CHD show regionally circumscribed alterations in functional connectivity and language vulnerabilities, while the associations between connectivity and executive and motor functioning appear to extend across both CHD and typically developing children.

To ensure optimal visuomotor feedback control during manual tracking, the brain must continuously monitor the error between the hand and the target. Modulations in the theta band (3-8 Hz) are related to error processing, but this has been mainly shown in cognitive control contexts. Hence, their relationship with hand-target errors during online control remains unclear. Here we assessed the impact of motor error processing on EEG theta-band activity in 29 healthy participants while they performed continuous tracking of a moving target with their dominant (right) hand. Two conditions were used to manipulate error processing demands: 1) in the Repeated condition, the same target trajectory was presented 80 times, allowing participants to implicitly learn the pattern and reduce tracking errors; 2) in the Random condition, 80 different trajectories were used, inducing persistent high tracking errors. Behavioral analyses confirmed that tracking errors were significantly higher in the Random than in the Repeated condition. Importantly, EEG theta power was also significantly higher in the Random condition, with a peak difference occurring at electrodes overlaying the left sensorimotor regions. This effect was selective to theta activity, as there was no modulation in alpha- (8-12 Hz) and beta-band (15-30 Hz) activity. Overall, this study extends the role of theta oscillations to online error processing in the context of motor control. It is possible that theta modulations reflected cortical activity mediating the communication and integration of information within sensorimotor circuits including the motor, premotor and parietal cortex, which are known to mediate online movement control.

Background/Objectives: Congenital heart disease (CHD) is associated with altered brain development and an increased risk of neurodevelopmental difficulties, particularly in more severe forms of the condition. Although alterations in functional brain connectivity have been reported before and after the first corrective surgery in early infancy, as well as in adulthood, little is known about their presentation in early childhood and their association with neurodevelopmental outcomes. This study aimed to characterize resting-state functional connectivity in 3-year-old children with moderate-to-severe CHD and to examine its associations with neurodevelopmental outcomes, including cognitive, language, and motor abilities. Methods: Twenty-five 3-year-old children with moderate-to-severe CHD and 28 age-matched healthy controls completed resting-state functional near-infrared spectroscopy (fNIRS) and a standardized neurodevelopmental assessment. Functional brain connectivity was examined across frontal, fronto-parietal, left and right fronto-temporal, and inter-hemispheric networks. Group differences were analyzed using ANCOVAs controlling for socioeconomic status (maternal SES) and with sex as a factor. Associations between functional brain connectivity and neurodevelopmental measures were examined using hierarchical linear regression models adjusted for diagnostic group, sex, and socioeconomic status, with connectivity-by-group interactions tested to assess group differences in these associations. Results: Children with moderate-to-severe CHD showed overall lower resting-state functional connectivity and poorer language performance than controls. Greater interhemispheric functional connectivity was associated with fewer executive function difficulties across participants, with no significant differences in these associations between groups. Conclusions: Preschool-aged children with CHD show altered functional connectivity and language vulnerabilities, while the association between interhemispheric connectivity and executive functioning appears to extend across both CHD and typically developing children.