Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental impairments. A systematic neurodevelopmental screening program was implemented at the Necker Children's Hospital. We aimed to describe screening outcomes according to a previously published theoretical neurodevelopmental risk classification and to identify associated risk factors.

Neurodevelopmental screening was conducted during pediatric cardiology visits at Necker Children's Hospital (January 2024–September 2025) using parent-completed ASQ-3, M-CHAT, and SDQ questionnaires with standard cut-offs. Children were classified into four theoretical neurodevelopmental risk groups, and outcomes were compared across groups using multivariable logistic regression within risk strata.

A total of 255 children with isolated CHD were included (mean age 23 ± 19 months; 55% male) and 21% were born preterm. Overall, 69% underwent open-heart surgery and 40% required neonatal surgery. According to theoretical neurodevelopmental risk, 29% were classified as very high risk, 27% high risk, 31% moderate risk, and 13% low risk. Overall, 68% screened positive on the ASQ-3 and 25% on the M-CHAT; among children completing the SDQ ( n = 31), 65% showed elevated behavioral risk. Screening outcomes did not differ across risk categories in the overall cohort; however, after exclusion of preterm-born children, severe ASQ impairment (≥1 severe domain) was observed in 49%, 35%, 36%, and 33% across the predefined neurodevelopmental risk groups, showing a non-significant trend toward higher rates in the very high-risk group ( P = 0.10). In the high/very high-risk no perinatal or surgical determinants were associated with increased neurodevelopmental impairment. In the moderate/low-risk groups, longer cardiopulmonary bypass duration was associated with positive ASQ-3 screening (OR 5.84, 95% CI [1.12–30.47], P = 0.04).

Nearly 70% of children with isolated CHD screened positive for neurodevelopmental impairments in a systematic screening program. Although the theoretical risk stratification provides a relevant framework, voluntary participation likely enriched the cohort with families expressing developmental concerns, potentially attenuating differences between risk groups. Integrating standardized questionnaires into routine cardiology follow-up appears effective in identifying vulnerable children, including those classified as moderate or low risk.