Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-30T21:57:05.019Z Has data issue: false hasContentIssue false
  • English
  • Français

Prediction of preschool functional abilities after early complex cardiac surgery

Published online by Cambridge University Press:  30 April 2014

Gwen Y. Alton ,
Soreh Taghados ,
Ari R. Joffe ,
Charlene M. T. Robertson ,
Irina Dinu  and
the Western Canadian Pediatric Therapies Follow-Up Group
Gwen Y. Alton*
Affiliation:
Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
Soreh Taghados
Affiliation:
School of Public Health, University of Alberta, Edmonton, Alberta, Canada
Ari R. Joffe
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Charlene M. T. Robertson
Affiliation:
Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Pediatric Rehabilitation Outcomes Evaluation and Research Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
Irina Dinu
Affiliation:
School of Public Health, University of Alberta, Edmonton, Alberta, Canada
*
Correspondence to: G. Y. Alton, RN, MN, Rm 242C, Glen East, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, Alberta, Canada T5G 0B7. Tel: 780 735-7999, ext: 15630; Fax: 780 735-7907; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: It is important to identify early predictors of functional limitations in children after congenital heart surgery to optimise their independence as they prepare for school. The purpose of this study is to determine potentially modifiable predictor variables of functional abilities in pre-school children who underwent complex cardiac surgery at 6 weeks of age or earlier. Methods: This prospective inception cohort study comprised a sample of 165 survivors (63% boys) who had complex cardiac surgery (75% biventricular repairs) at Stollery Children’s Hospital, Edmonton, Alberta. We excluded children with chromosomal abnormalities. When children were 4–5 years of age, the parents completed the Adaptive Behavioral Assessment System II. Regression analysis was used to assess the association between multiple risk factors and each of the four continuous composite scores. Results: The mean scores for the practical domain and general adaptive composite score of the Adaptive Behavioural Assessment System were lower than the conceptual and social domains, with 13.3% of the children having a delay in the practical domain. There was a significant association between the general adaptive (p=0.003; 0.012), conceptual (p=0.0004; 0.042), social (p=0.0007; 0.028), and the practical (p=0.046; 0.003) domain composite scores with the mother’s education and preoperative plasma lactate, respectively. Conclusion: Maternal education may be a marker for the social context of children, and warrants societal attention to improve functional outcomes. Preoperative lactate as a potentially modifiable variable may warrant increased attention to early diagnosis and aggressive resuscitation of young infants with congenital heart disease.

Keywords

Adaptive behaviourcongenital cardiac surgerypre-school functionpredictionoutcomes
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 4 , April 2015 , pp. 655 - 662
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The first author position is equally shared with Soreh Taghados.

**

The Western Canadian Pediatric Therapies Follow-Up Group consists of: Patricia Blakely, Saskatoon, SK; Reg Sauvé, Calgary; Diane Moddemann, Winnipeg; Jaya Bodani, Regina, SK; Anne Synnes, Vancouver, BC.

References

1. Rudolph, AM. Congenital Diseases of the Heart: Clinical-Physiological Considerations, 2nd edn. Futura Publishing, Armonk, NY, 2001.Google Scholar
2. Shillingford, AJ, Wernovsky, G. Academic performance and behavioral difficulties after neonatal and infant heart surgery. Pediatr Clin N Am 2004; 51: 1625–1639.Google Scholar
3. Robertson, CMT, Sauvé, RS, Joffe, AR, et al. The Registry and Follow-up of Complex Pediatric Therapies Program of Western Canada: a mechanism for service, audit, and research after life-saving therapies for young children. Cardiol Res Pract 2011: 965740.Google Scholar
4. Alton, GY, Rempel, GR, Robertson, CMT, Newburn-Cook, CV, Norris, CM. Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation. Cardiol Young 2010; 20: 668–675.Google Scholar
5. Majnemar, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr 2008; 153: 55–60.Google Scholar
6. Larsen, SH, McCrindle, BW, Jacobsen, EB, Johnsen, SP, Emmertsen, K, Hjortdal, VE. Functional health status in children following surgery for congenital heart disease: a population-based cohort study. Cardiol Young 2010; 20: 631–640.Google Scholar
7. Creighton, DE, Robertson, CMT, Sauvé, RS, et al. Neurocognitive, functional, and health outcomes at 5 years of age for children after complex cardiac surgery at 6 weeks of age or younger. Paediatrics 2007; 120: 478–486.CrossRefGoogle ScholarPubMed
8. Menahem, S, Poulakis, Z, Prior, M. Children subjected to cardiac surgery for congenital heart disease. Part 1 – emotional and psychological outcomes. Interact Cardiovasc Thorac Surg 2008; 7: 600–604.CrossRefGoogle ScholarPubMed
9. Amianto, F, Bergui, GC, Abbate-Daga, G, Bellicanta, A, Munno, D, Fassino, S. Growing up with a congenital heart disease: neuro-cognitive, psychopathological and quality of life outcomes. Panminerva Med 2011; 53: 109–127.Google Scholar
10. Hövels-Gürich, HH, Seghaye, MC, Däbritz, S, Messmer, BJ, von Bernuth, G. Cognitive and motor development in preschool and school-aged children after neonatal arterial switch operation. J ThoracCardiovas Surg 1997; 114: 578–585.Google Scholar
11. Gaynor, JW, Gerdes, M, Nord, AS, et al. Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy? J Thorac Cardiovasc Surg 2010; 140: 1230–1237.Google Scholar
12. Majnemer, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Gender differences in the developmental outcomes of children with congenital cardiac defects. Cardiol Young 2012; 22: 514–519.CrossRefGoogle ScholarPubMed
13. Majnemar, A, Limperopoulos, C, Shevell, MI, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. A new look at outcomes of infants with congenital heart disease. Pediatr Neurol 2007; 40: 197–204.Google Scholar
14. McGrew, K, Bruininks, R. The factor structure of adaptive behavior. School Psychol Rev 1989; 18: 64–81.Google Scholar
15. Harrison, PL, Oakland, T. Manual of the Adaptive Behaviour Assessment System II. Psychological Corp, Harcourt Assessment Company, San Antonio, Texas, 2003.Google Scholar
16. American Association on Mental Retardation. Mental Retardation: Definition, Classification, and Systems of Support. American Association on Mental Retardation, Washington, DC, 2002.Google Scholar
17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Text Revision, DSM-IV-TR, 4th edn. American Psychiatric Association, Washington, DC, 2000.Google Scholar
18. Robertson, CMT, Joffe, AR, Sauvé, RS, et al. Outcomes from an interprovincial program of newborn open heart surgery. J Pediatr 2004; 144: 86–92.Google Scholar
19. Blishen, RR. The 1981 socioeconomic index for occupations in Canada. Can Res Soc Anth 1987; 24: 465–488.Google Scholar
20. Freed, DH, Robertson, CMT, Sauvé, RS, et al. Intermediate-term outcomes of the arterial switch operation for transposition of the great arteries in neonates: alive but well? J Thorac Cardiovasc Surg 2006; 132: 845–852.CrossRefGoogle ScholarPubMed
21. Cheung, PY, Chui, N, Joffe, RA, Rebeyka, IM, Robertson, CMT. The Western Canadian Complex Pediatric Therapies Follow-up Group. Post-operative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: a cohort follow-up to 18 months. J Thorac Cardiovasc Surg 2005; 130: 837–843.CrossRefGoogle ScholarPubMed
22. Alton, GY, Robertson, CMT, Sauvé, RS, et al. Early childhood health, growth, and neurodevelopmental outcomes after complete repair of total anomalous pulmonary venous correction at 6 weeks or younger. J Thorac Cardiovasc Surg 2007; 133: 905–911.Google Scholar
23. Atallah, J, Dinu, IA, Joffe, AR, et al. Two-year survival and mental psychomotor outcomes after the Norwood Procedure: an analysis of the modified Blalock–Taussig shunt and right ventricle-to-pulmonary artery shunt surgical eras. Circulation 2008; 118: 1410–1418.Google Scholar
24. Forbess, JM, Visconti, KJ, Hancock-Friesen, C, Howe, RC, Bellinger, DC, Jonas, RA. Neurodevelopmental outcome after congenital heart surgery: results from an institutional registry. Circulation 2002; 106 (Suppl 1): I95–I102.Google Scholar
25. Wernovsky, G, Stiles, KM, Gauvreau, K, et al. Cognitive development after the Fontan operation. Am Heart Assoc 2000; 102: 883–889.Google ScholarPubMed
26. McCusker, CG, Doherty, NN, Molloy, B, et al. A randomized controlled trial of interventions to promote adjustment in children with congenital heart disease entering school and their families. J Pediatr Psychol 2012; 37: 1089–1103.CrossRefGoogle ScholarPubMed
27. Lipstein, EA. Helping “vulnerable” children – and their parents- lead normal lives. Contemporary Pediatr 2006; 23: 26–37.Google Scholar
28. Sparrow, S, Balla, DA, Cicchhetti, DV. Vineland Adaptive Behavior Scales, Interview Edition. Survey Form Manual; A Revision of the Vineland Social Maturity Scale of EA Doll. American Guidance Service, Circle Pines, MN, 1984.Google Scholar