Later Competence and Adaptation in Infants Who Survive Severe Heart Defects

Abstract

A model of risk potential for developmental outcome was created based on cardiac, medical, surgical, and family-stress factors in 31 children with transposition of the great arteries who had undergone reparative open heart surgery utilizing cardiopulmonary bypass during infancy. Impact of these potential risk factors was assessed by 4 current neurologic measures (neurologic anatomic abnormalities, functional impairment, electroencephalograph [EEG], and Pattern Visual Evoked Potential [PVEP]) and 4 psychologic measures (IQ, achievement, perceptual-motor function, and behavior). Results indicated that adverse developmental outcome was significantly associated with the following medical risk variables: failure of palliative surgery to alleviate hypoxia, prolonged hypoxia, growth failure, congestive heart failure, absence of ameliorating shunting heart defects, stroke, and CNS infection; and two psychosocial moderator variables: socioeconomic status and current life stress. Analysis of a "cumulative risk score" indicated significantly higher risk scores in children with abnormal EEGs, PVEPs, and neurologic examinations. The cumulative risk score highly correlated with composite neurologic outcome (r = .62), IQ (r = -.66), achievement (r = -.60), and perceptual-motor function (r = -.48). While overall outcome was favorable for children with TGA who experienced a single risk event, outcome was compromised if multiple risk factors occurred.

Prediction of behavioural and emotional problems in children and adolescents with operated congenital heart disease

“…In view of our results (deep hypothermic circulatory arrest appeared to be a predictor of long-term behavioural/emotional problems), we agree with the conclusion of Oates et al However, care should be taken when drawing firm conclusions since in our study the duration of deep hypothermic circulatory arrest and rate of cooling were not documented in a reliable manner. Several investigators have reported on the psychosocial sequelae of risk factors such as duration of pregnancy, hypoxia and age at surgical repair [1,5,7,18,19] . In a longitudinal study Weisglas-Kuperus et al [18] found that parents of very low birth weight children with a gestational age <36 weeks reported significantly more CBCL-Internalizing problems when their children were 3·5 years of age, than parents of a comparison group.…”

“…In a longitudinal study Weisglas-Kuperus et al [18] found that parents of very low birth weight children with a gestational age <36 weeks reported significantly more CBCL-Internalizing problems when their children were 3·5 years of age, than parents of a comparison group. O'Dougherty et al [5] found that prolonged hypoxia was one of several medical risk variables significantly associated with adverse psychosocial outcome in patients with transposition of the great arteries. In contrast, Oates et al [7] recently found no adverse effect from prolonged hypoxia on the intellectual development of 81 children who had cyanotic heart disease (transposition of the great arteries and tetralogy of Fallot).…”

“…Jedlicka-Kö hler et al [19] reported that the length of interval between operation and psychological testing, but not age of repair, was a significant predictor of intellectual functioning. O'Dougherty et al [5] stressed the importance of using multiple medical risk factors in assessing the risk potential of congenital heart disease children.…”

“…Few follow-up studies have been conducted in this field and these often contained methodological flaws, such as small sample size and non-standardized assessment procedures, which makes it difficult to draw firm conclusions. Furthermore, several investigators reported contradictory results, varying from negative outcomes such as poor emotional, social or intellectual adjustment [1][2][3][4] to favourable outcomes [5][6][7] . It has been suggested in the literature that several medical factors may put congenital heart disease children at increased risk of developing later adjustment problems, such as age at surgical repair, medical complications during or after surgery, number of operations, and concomitant extracardiac anomalies [5,6] .…”

In vivo effect of chronic hypoxia on the neurochemical profile of the developing rat hippocampus

“…In children with CHD, long-term studies using standardized tests of academic achievement have demonstrated lower scores compared with the controls [54]. Multiple risk factors such as chronic hypoxia, anesthesia, and potentially low cerebral blood flow during cardiopulmonary bypass may be responsible for these learning disabilities [35][36][37].…”