hollyduck
04-11-08, 09:33 AM
Infants With Heart Disease at Higher Risk for Attention and Behavioral Difficulties (http://www.medscape.com/viewarticle/572800)
Authors: Caroline Cassels, Laurie Barclay, MD, Brande Nicole Martin
April 10, 2008 — Children who have undergone surgery as infants for complex congenital heart disease (CHD) are at a significantly increased risk for inattention and hyperactivity, with nearly half requiring remedial school services, a new study shows.
The study of 109 children who had cardiac surgery for complex CHD before 2 months of age showed that they were 3 to 4 times more likely to have clinically significant scores on ratings scales for inattention and hyperactivity compared with their counterparts in the general population. Furthermore, by school age, 49% were receiving some form of remedial academic services and 15% were assigned to a special education classroom.
[...]
The study is published in the April issue of Pediatrics.
... the study was prompted by anecdotal observations that children with complex CHD appeared to be more inattentive and hyperactive and by data from previous studies that investigated neurologic outcomes in children with CHD.
The study's primary outcome was to use questionnaire data to characterize problems with inattention and hyperactivity and the use of remedial school services in a population of 5- to 10-year-olds who underwent newborn cardiac surgery for complex CHD.
[...]
Data were obtained from parents and teachers for the 109 children. The mean age of the cohort at the time of completion of the questionnaires was 7.9 years, and 67% were boys... Based on parent reports, 18% of the children had repeated a grade. In addition, teachers reported that 14% to 20% of children performed "well below average" in 1 or more subjects. A total of 15% of the children were in a full-time special education classroom; 21% received remedial help in math or reading, or both, within the classroom, and 13% were removed from the classroom to receive remedial help in math or reading, or both.
In behavior assessment, 14% of children had abnormal scores from both parents and teachers for inattention, 13% had abnormal scores for hyperactivity, and 5.5% of the children had abnormal scores for both inattention and hyperactivity.
Based on ADHD-IV threshold scores, the study showed that 5% of the subjects would be highly likely to have ADHD and an additional 15% would be considered at risk of having ADHD.
The researchers were unable to identify statistically significant associations between any of the targeted preoperative, intraoperative, and postoperative variables and high-risk scores for inattention and hyperactivity or the need for remedial school services within the classroom.
Although no perioperative factors were statistically associated with adverse outcomes, the authors note that the study was suboptimally powered. Therefore, they note, it is possible that risk factors associated with surgery could be identified in a larger sample.
On the other hand, said Dr. Shillingford, it is possible that the fetal environment also plays a role.
"One of my theories is that these outcomes are probably related to the fetal environment. There may well be alterations in the fetal physiology including the genetic milieu and oxygen delivery to the brain which may impact how the child responds to subsequent high-risk events, including surgery," she said.
The study was supported by the National Institute for Neurological Disorders and Stroke, National institutes of Health. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2008;121:e759-e767.
Authors: Caroline Cassels, Laurie Barclay, MD, Brande Nicole Martin
April 10, 2008 — Children who have undergone surgery as infants for complex congenital heart disease (CHD) are at a significantly increased risk for inattention and hyperactivity, with nearly half requiring remedial school services, a new study shows.
The study of 109 children who had cardiac surgery for complex CHD before 2 months of age showed that they were 3 to 4 times more likely to have clinically significant scores on ratings scales for inattention and hyperactivity compared with their counterparts in the general population. Furthermore, by school age, 49% were receiving some form of remedial academic services and 15% were assigned to a special education classroom.
[...]
The study is published in the April issue of Pediatrics.
... the study was prompted by anecdotal observations that children with complex CHD appeared to be more inattentive and hyperactive and by data from previous studies that investigated neurologic outcomes in children with CHD.
The study's primary outcome was to use questionnaire data to characterize problems with inattention and hyperactivity and the use of remedial school services in a population of 5- to 10-year-olds who underwent newborn cardiac surgery for complex CHD.
[...]
Data were obtained from parents and teachers for the 109 children. The mean age of the cohort at the time of completion of the questionnaires was 7.9 years, and 67% were boys... Based on parent reports, 18% of the children had repeated a grade. In addition, teachers reported that 14% to 20% of children performed "well below average" in 1 or more subjects. A total of 15% of the children were in a full-time special education classroom; 21% received remedial help in math or reading, or both, within the classroom, and 13% were removed from the classroom to receive remedial help in math or reading, or both.
In behavior assessment, 14% of children had abnormal scores from both parents and teachers for inattention, 13% had abnormal scores for hyperactivity, and 5.5% of the children had abnormal scores for both inattention and hyperactivity.
Based on ADHD-IV threshold scores, the study showed that 5% of the subjects would be highly likely to have ADHD and an additional 15% would be considered at risk of having ADHD.
The researchers were unable to identify statistically significant associations between any of the targeted preoperative, intraoperative, and postoperative variables and high-risk scores for inattention and hyperactivity or the need for remedial school services within the classroom.
Although no perioperative factors were statistically associated with adverse outcomes, the authors note that the study was suboptimally powered. Therefore, they note, it is possible that risk factors associated with surgery could be identified in a larger sample.
On the other hand, said Dr. Shillingford, it is possible that the fetal environment also plays a role.
"One of my theories is that these outcomes are probably related to the fetal environment. There may well be alterations in the fetal physiology including the genetic milieu and oxygen delivery to the brain which may impact how the child responds to subsequent high-risk events, including surgery," she said.
The study was supported by the National Institute for Neurological Disorders and Stroke, National institutes of Health. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2008;121:e759-e767.