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Mercer-Rosa L, Favilla E. Neurodevelopment in patients with repaired tetralogy of Fallot. Front Pediatr 2024; 12:1137131. [PMID: 38737635 PMCID: PMC11082288 DOI: 10.3389/fped.2024.1137131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/14/2024] [Indexed: 05/14/2024] Open
Abstract
Neurodevelopmental sequelae are prevalent and debilitating for patients with congenital heart defects. Patients born with tetralogy of Fallot (TOF) are susceptible for abnormal neurodevelopment as they have several risk factors surrounding the perinatal and perioperative period. Some risk factors have been well described in other forms of congenital heart defects, including transposition of the great arteries and single ventricle heart disease, but they have been less studied in the growing population of survivors of TOF surgery, particularly in infancy and childhood. Adolescents with TOF, even without a genetic syndrome, exhibit neuro-cognitive deficits in executive function, visual-spatial skills, memory, attention, academic achievement, social cognition, and problem-solving, to mention a few. They also have greater prevalence of anxiety disorder, disruptive behavior and attention-deficit hyperactivity disorder. These deficits impact their academic performance, social adjustment, and quality of life, thus resulting in significant stress for patients and their families. Further, they can impact their social adjustment, employment and career development as an adult. Infants and younger children can also have significant deficits in gross and fine motor skills, cognitive deficits and abnormal receptive language. Many of the risk factors associated with abnormal neurodevelopment in these patients are not readily modifiable. Therefore, patients should be referred for evaluation and early intervention to help maximize their neurodevelopment and improve overall outcomes. More study is needed to identify potentially modifiable risk factors and/or mediators of neurodevelopment, such as environmental and socio-economic factors.
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Affiliation(s)
- Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Daughtrey HR, Lee J, Boothroyd DB, Burnside GM, Shaw RJ, Anand KJS, Sanders LM. Stress Symptoms Among Children and Their Parents After ICU Hospitalization. J Intensive Care Med 2024; 39:328-335. [PMID: 37743757 DOI: 10.1177/08850666231201836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective: Child survival after intensive care unit (ICU) hospitalization has increased, yet many children experience acute stress that may precipitate mental/behavioral health comorbidities. Parents report stress after their child's hospitalization. Little is known about the individual and family characteristics that may moderate intergenerational relationships of acute stress. Design: Following ICU admission at a large academic medical center, a prospective cross-sectional cohort study assessed the associations between intergenerational characteristics and acute stress among children and families. Patients: Parent-child dyads (N = 88) were recruited from the pediatric ICU and pediatric cardiovascular ICU (CVICU) following ICU discharge. Eligible children were between 8 and 18 years old with ICU stays longer than 24 hours. Children with developmental delays were excluded. Caregivers were proficient in English or Spanish. Surveys were collected before hospital discharge. Measurements/Main Results: The primary outcome was "child stress" defined as a score≥17, measured by the Children's Revised Impact of Events Scale (CRIES-8). "Parent stress" was defined as an elevated composite score on the Stanford Acute Stress Reaction Questionnaire. We used validated scales to assess the child's clinical and family social characteristics. Acute stress was identified in 34 (39.8%) children and 50 (56.8%) parents. In multivariate linear regression analyses adjusting for social characteristics, parent stress was associated with increased risk of child stress (adjusted odds ratio 2.58, 95% confidence interval 0.69, 4.46, p < .01). In unadjusted analyses, Hispanic ethnicity was associated with greater child stress. In adjusted analyses, race, income, ICU length of stay, and language were not associated with child stress and did not moderate the parent-child stress relationship. Conclusions: Parent stress is closely correlated with child stress during ICU hospitalization. Hispanic ethnicity may be associated with increased risk for child stress, but further studies are required to define the roles of other social and clinical measures.
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Affiliation(s)
- Hannah R Daughtrey
- Pediatric Cardiac Critical Care Medicine, Children's National Heart Institute, Washington, DC, USA
| | - Justin Lee
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Derek B Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Georgiana M Burnside
- Pediatric Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA, USA
| | - Kanwaljeet J S Anand
- Pediatric Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA, USA
| | - Lee M Sanders
- Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, CA, USA
- Academic General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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Mustafa Kamal N, Salih AF, Ali BM. Assessment of Health-Related Quality of Life in Children with Totally Corrected Tetralogy of Fallot in Sulaymaniyah, Iraq. J Community Health Nurs 2024; 41:123-137. [PMID: 37905724 DOI: 10.1080/07370016.2023.2272996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE This study examined the health-related quality of life among children who have undergone surgery for tetralogy of Fallot (TOF) compared to healthy children. DESIGN Cross-sectional study. METHODS The study was carried out at Children's Heart Hospital and Primary Healthcare Centers in Sulaymaniyah, Iraq, between July 1, 2022, and November 1, 2022. The study involved 400 participants, comprised of 200 parents of healthy children and 200 parents with children with repaired TOF. Data collection involved utilizing a 5-point Likert Scale questionnaire administered through direct face-to-face interviews with the parents of the children. FINDINGS Children with surgically repaired TOF had markedly lower mean scores (P ≤ 0.001) in the overall dimension of QoL (Mean rank = 137) when compared to healthy children (Mean rank = 263). Furthermore, it was observed that children with repaired TOF had significantly lower mean scores (P < 0.001) across all subdimensions of QoL compared to their healthy counterparts. In the subject of children with repaired TOF, the impact of maternal education (illiterate and lower education) on overall QoL was found to be highly significant (P < 0.001). In addition, children with repaired TOF from lower socioeconomic status (SES) families had worse quality of life than those from medium and high SES families, with a p-value <0.001. CONCLUSIONS Repaired TOF children exhibited notable deficiencies across all dimensions of QoL compared to healthy children. Moreover, SES emerged as a significant determinant influencing the QoL outcomes of repaired TOF children. CLINICAL EVIDENCE Despite undergoing corrective surgery for TOF, the QoL in children with repaired TOF continues to be lower than that of their healthy counterparts. Notably, the economic and educational status of the family significantly impacts the way these children perceive and experience their QoL. This finding underscores the critical significance of factoring in socioeconomic elements when addressing the well-being of this particular group of children.
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Affiliation(s)
- Niaz Mustafa Kamal
- Community Health, Pediatrics Nursing Department, Technical Institute, Sulaimani Polytechnic University, Sulaymaniyah, Iraq
| | - Aso Faiq Salih
- Pediatric Cardiology, Pediatrics Department, College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
| | - Bushra Mohammed Ali
- Family and Community Medicine Department, University of Sulaimani, Sulaymaniyah, Iraq
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Tesson S, Swinsburg D, Nielson-Jones C, Costa DSJ, Winlaw DS, Badawi N, Sholler GF, Butow PN, Kasparian NA. Mother-Infant Dyadic Synchrony and Interaction Patterns After Infant Cardiac Surgery. J Pediatr Psychol 2024; 49:13-26. [PMID: 37873696 DOI: 10.1093/jpepsy/jsad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/19/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Parents and their infants with complex congenital heart disease (CHD) face relational challenges, including marked distress, early separations, and infant hospitalizations and medical procedures, yet the prevalence of parent-infant interaction difficulties remains unclear. Using a standardized observational paradigm, this study investigated mother-infant dyadic synchrony, interactional patterns, and associated predictors in mother-infant pairs affected by CHD, compared with typically-developing pairs. METHODS In this prospective, longitudinal cohort study, mothers and their infants requiring cardiac surgery before age 6-months (n=110 pairs) and an age- and sex-matched Australian community sample (n=85 pairs) participated in a filmed, free-play interaction at 6.9±1.0 months. Mother-infant dyadic synchrony, maternal and infant interactional patterns, and relational risk were assessed using the Child-Adult Relationship Experimental (CARE) Index. Maternal and infant predictors were assessed at 32 weeks gestation, 3- and 6-months postpartum. RESULTS Most mother-infant interactions were classified as "high risk" or "inept" (cardiac: 94%, control: 81%; p=.007). Dyadic synchrony (p<.001), maternal sensitivity (p=.001), and infant cooperativeness (p=.001) were lower for cardiac than control pairs. Higher maternal traumatic stress at 6-months postpartum predicted lower dyadic synchrony for mother-infant pairs affected by CHD (B=-.04, p=.03). Dyadic synchrony was higher among older infants in the total (B=.40, p=.003) but not cardiac sample (B=.24, p=.06). CONCLUSIONS Relational difficulties were almost universal among mother-infant pairs affected by CHD and were also high in the Australian community sample. Widespread education initiatives are recommended to increase awareness of heightened mother-infant relational risk in congenital heart care and well-child settings, alongside relationally-focused prevention and early intervention programs.
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Affiliation(s)
- Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- School of Psychology, The University of Sydney, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dianne Swinsburg
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Claudia Nielson-Jones
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Australia
- Pain Management Research Institute, Royal North Shore Hospital, Australia
| | - David S Winlaw
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Australia
| | - Nadine A Kasparian
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
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Zhang Y, Zhou H, Bai Y, Chen Z, Wang Y, Hu Q, Yang M, Wei W, Ding L, Ma F. Families under pressure: A qualitative study of stressors in families of children with congenital heart disease. Stress Health 2023; 39:989-999. [PMID: 36809656 DOI: 10.1002/smi.3240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
The objective of this study was to better understand the stressors in families of children with congenital heart disease (CHD) to assist with formulating targeted stress management plans for such families. A descriptive qualitative study was undertaken at a tertiary referral hospital in China. Following purposeful sampling, interviews were conducted with 21 parents of children with CHD regarding the stressors in their families. Following content analysis, 11 themes were generated from the data and categorised into six main domains: the initial stressor and associated hardships, normative transitions, prior strains, the consequences of family efforts to cope, intrafamily and social ambiguity, and sociocultural values. The 11 themes include confusion regarding the disease, hardships encountered during treatment, the heavy financial burden, the unusual growth track of the child due to the disease, normal events becoming abnormal for the family, impaired family functioning, family vulnerability, family resilience, family boundary ambiguity induced by role alteration, a lack of knowledge about community support and family stigma. Various and complex stressors exist for families of children with CHD. Medical personnel should fully evaluate the stressors and take targeted measures before implementing family stress management practices. It is also necessary to focus on the posttraumatic growth of families of children with CHD and strengthen resilience. Moreover, family boundary ambiguity and a lack of knowledge about community support should not be ignored, and further research is needed to explore these variables. Most importantly, policymakers and healthcare providers should adopt a range of strategies to address the stigma of being in a family of a child with CHD.
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Affiliation(s)
- Yi Zhang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hang Zhou
- Psychiatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yangjuan Bai
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhisong Chen
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjiao Wang
- Psychiatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiulan Hu
- ICU in Geriatric Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingfang Yang
- Urology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Wei
- Neurosurgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lan Ding
- General Surgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fang Ma
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Liu SJ, Yen WJ, Chang YZ, Ku MS. Impact of educational videos on maternal anxiety caused by children's heart surgery. Nurs Crit Care 2023; 28:1106-1114. [PMID: 35686512 DOI: 10.1111/nicc.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mothers of children undergoing surgery for congenital heart disease experience significant stress. Therefore, finding a strategy to decrease this is vital. AIMS To examine whether adding educational digital video discs to routine education can reduce maternal anxiety and depression when their children undergo heart surgery and when surgical or post-surgical complications occur. STUDY DESIGN In a teaching hospital, 120 mothers whose children underwent elective heart surgery were randomly and equally divided into two groups: mothers receiving routine education plus a digital video disc before surgery and mothers receiving only routine education. Mothers' anxiety and depression levels were compared before education, after education (before surgery), and on discharge day. The effect of watching the digital video disc on maternal anxiety and depression on discharge day was evaluated for the participants whose children had surgical or post-surgical complications. RESULTS Compared with only routine education, mothers' anxiety after education and on the discharge day decreased more if digital video disc was added. Depression decreased more after education, but no difference was found on the discharge day. Anxiety levels of mothers whose children had surgical or post-surgical complications on the discharge day decreased more if they watched the digital video disc, compared with those receiving only routine education (Beck anxiety inventory score 3.4 ± 1.9 and 6.1 ± 2.4 respectively; p-value .001). CONCLUSIONS Compared with only routine education, adding digital video disc could decrease mothers' anxiety, and until the day of discharge. Compared with only routine education, adding digital video disc could decrease mothers' anxiety on the discharge day if their child had surgical or post-surgical complications. RELEVANCE TO CLINICAL PRACTICE Adding educational digital video disc to routine education could decrease mothers' anxiety until the day of discharge. It could also decrease mothers' anxiety if their child had surgical or post-surgical complications.
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Affiliation(s)
- Shu-Juan Liu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Jiuan Yen
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Drug Testing Center, Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Min-Sho Ku
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
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Ehrler M, Wettach C, Beck I, Valsangiacomo Buechel ER, Latal B, Landolt MA. Mental health-related quality of life in mothers of children with surgically repaired congenital heart disease: a 13-year longitudinal study. Qual Life Res 2023; 32:2975-2986. [PMID: 37248407 PMCID: PMC10474212 DOI: 10.1007/s11136-023-03440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
AIMS Having a child with congenital heart disease (CHD) can affect parental health-related quality of life (HR-QoL). We investigated the long-term trajectories of mental HRQoL (m-HRQoL) in mothers of children with CHD and examined risk factors for persistent low m-HRQoL. METHODS One hundred twenty-five mothers of children with CHD completed a standardized questionnaire on m-HRQoL (mental subscale SF-12) after the children's first open-heart surgery and subsequently when the children were 1, 4, 6, 10, and 13 years old. A z-score for m-HRQoL was calculated with national norms. Latent class growth analysis (LCGA) was used to identify subgroups of mothers with regards to their m-HRQoL trajectories over time. Regression analysis investigated predictors for chronically low m-HRQoL. RESULTS Compared to norms, mothers of children with CHD had significantly lower m-HRQoL immediately after open-heart surgery (β = -0.30 (CI-95: -0.44, -0.15)). Subsequently, m-HRQoL increased to a normal level (m-HRQoL compared to the norm from 1 to 13 years: β ranges between 0.05 and 0.27). LCGA revealed two distinct groups of m-HRQoL trajectories: A group with normal m-HRQoL (75% of mothers, means z-scores range between - 0.76 and 0.62) and a group with chronically low m-HRQoL (25% of mothers, mean z-scores range between -1.32 and -0.10). Chronically, low m-HRQoL was associated with poorer social support (OR = 3.39 (CI-95: 1.40, 8.49), p = 0.008) but not with parental education, migration background, number of open-heart surgeries, diagnosis of a univentricular CHD, or low IQ. CONCLUSION A quarter of mothers of children with CHD have chronically low m-HRQoL throughout their child's development, especially those mothers with poor social support. Further studies of family-oriented approaches are needed to identify and support these mothers and reinforce parental well-being.
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- URPP Adaptive Brain Circuits in Development and Learning, University of Zurich, Zurich, Switzerland
| | - Corina Wettach
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ingrid Beck
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatrics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Emanuela R Valsangiacomo Buechel
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Division of Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus A Landolt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
- Division of Child and Adolescent Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.
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Moderate and Severe Congenital Heart Diseases Adversely Affect the Growth of Children in Italy: A Retrospective Monocentric Study. Nutrients 2023; 15:nu15030484. [PMID: 36771190 PMCID: PMC9919582 DOI: 10.3390/nu15030484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric patients with CHD and healthy controls. WHO and Italian z-scores for weight for age (WZ), length/height for age (HZ), weight for height (WHZ) and body mass index (BMIZ) were collected. A total of 657 patients (566 with CHD and 91 healthy controls) were enrolled: 255 had mild CHD, 223 had moderate CHD and 88 had severe CHD. Compared to CHD patients, healthy children were younger (age: 7.5 ± 5.4 vs. 5.6 ± 4.3 years, p = 0.0009), taller/longer (HZ: 0.14 ± 1.41 vs. 0.62 ± 1.20, p < 0.002) and heavier (WZ: -0,07 ± 1.32 vs. 0.31 ± 1.13, p = 0.009) with no significant differences in BMIZ (-0,14 ± 1.24 vs. -0.07 ± 1.13, p = 0.64) and WHZ (0.05 ± 1.47 vs. 0.43 ± 1.07, p = 0.1187). Moderate and severe CHD patients presented lower z-scores at any age, with a more remarkable difference in children younger than 2 years (WZ) and older than 5 years (HZ, WZ and BMIZ). Stunting and underweight were significantly more present in children affected by CHD (p < 0.01). In conclusion, CHD negatively affects the growth of children based on the severity of the disease, even in a high-income country, resulting in a significant percentage of undernutrition in this population.
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Read JS, Brown K, Wray J. The Feasibility and Acceptability of Remote Videoconference Use of the Brief Developmental Assessment Tool for Young Children with Congenital Heart Disease. Telemed J E Health 2023; 29:146-151. [PMID: 35649232 DOI: 10.1089/tmj.2021.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Young children with congenital heart disease (CHD) are at heightened risk of developmental delay. The outbreak of COVID-19 and the ensuing lockdowns presented an opportunity to test the feasibility of using a short neurodevelopmental assessment tool-the Brief Developmental Assessment (BDA)-remotely via new technologies. Methods: We tested the feasibility and acceptability of remote testing of the tool's 6 domains of development with 30 children younger than 5 years with CHD and 10 healthy controls. Results: Despite some technical issues, parents largely responded positively to the use of the remote assessment as opposed to traditional face-to-face appointments, citing the beneficial saving of time, money, and childcare. Conclusions: The acceptability of the remote use of the BDA for the developmental screening of children with CHD will allow for the possibility of increased screening for more children and earlier identification of developmental problems, both during and after COVID-19 restrictions.
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Affiliation(s)
- Julie S Read
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Katherine Brown
- Heart and Lung Division, Zayed Centre for Rare Diseases Research, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
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10
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Tesson S, Butow PN, Marshall K, Fonagy P, Kasparian NA. Parent-child bonding and attachment during pregnancy and early childhood following congenital heart disease diagnosis. Health Psychol Rev 2021; 16:378-411. [PMID: 33955329 DOI: 10.1080/17437199.2021.1927136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diagnosis and treatment of congenital heart disease (CHD) can present challenges to the developing parent-child relationship due to periods of infant hospitalization and intensive medical care, parent-infant separations, child neurodevelopmental delay and feeding problems, and significant parent and child distress and trauma. Yet, the ways in which CHD may affect the parent-child relationship are not well-understood. We systematically reviewed the evidence on parental bonding, parent-child interaction, and child attachment following CHD diagnosis, according to a pre-registered protocol (CRD42019135687). Six electronic databases were searched for English-language studies comparing a cardiac sample (i.e., expectant parents or parents and their child aged 0-5 years with CHD) with a healthy comparison group on relational outcomes. Of 22 unique studies, most used parent-report measures (73%) and yielded mixed results for parental bonding and parent-child interaction quality. Observational results also varied, although most studies (4 of 6) found difficulties in parent-child interaction on one or more affective or behavioural domains (e.g., lower maternal sensitivity, lower infant responsiveness). Research on parental-fetal bonding, father-child relationships, and child attachment behaviour was lacking. Stronger evidence is needed to determine the nature, prevalence, and predictors of relational disruptions following CHD diagnosis, and to inform targeted screening, prevention, and early intervention programs for at-risk dyads.
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Affiliation(s)
- Stephanie Tesson
- School of Psychology, The University of Sydney, Sydney, Australia.,Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Sydney, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - Kate Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nadine A Kasparian
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia.,Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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11
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Hoskote A, Ridout D, Banks V, Kakat S, Lakhanpaul M, Pagel C, Franklin RC, Witter T, Lakhani R, Tibby SM, Anderson D, Tsang V, Wray J, Brown K. Neurodevelopmental status and follow-up in preschool children with heart disease in London, UK. Arch Dis Child 2021; 106:263-271. [PMID: 32907808 DOI: 10.1136/archdischild-2019-317824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/15/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe neurodevelopment and follow-up services in preschool children with heart disease (HD). DESIGN Secondary analysis of a prospectively collected multicentre dataset. SETTING Three London tertiary cardiac centres. PATIENTS Preschool children<5 years of age: both inpatients and outpatients. METHODS We analysed results of Mullen Scales of Early Learning (MSEL) and parental report of follow-up services in a representative convenience sample evaluated between January 2014 and July 2015 within a previous study. RESULTS Of 971 preschool children: 577 (59.4%) had ≥1 heart operation, 236 (24.3%) had a known diagnosis linked to developmental delay (DD) ('known group') and 130 (13.4%) had history of clinical event linked to DD. On MSEL assessment, 643 (66.2%) had normal development, 181 (18.6%) had borderline scores and 147 (15.1%) had scores indicative of DD. Of 971 children, 609 (62.7%) were not receiving follow-up linked to child development and were more likely to be under these services with a known group diagnosis, history of clinical event linked to DD and DD (defined by MSEL). Of 236 in known group, parents of 77 (32.6%) and of 48 children not in a known group but with DD 29 (60.4%), reported no child development related follow-up. DD defined by MSEL assessment was more likely with a known group and older age at assessment. CONCLUSIONS Our findings indicate that a 'structured neurodevelopmental follow-up pathway' in preschool children with HD should be considered for development and evaluation as children get older, with particular focus on those at higher risk.
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Affiliation(s)
- Aparna Hoskote
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Deborah Ridout
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Victoria Banks
- Information Office, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Suzan Kakat
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Monica Lakhanpaul
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Whittington Health NHS Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College of London, London, UK
| | - Rodney Cg Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Thomas Witter
- Paediatric Cardiology and Cardiac Surgery, Evelina London Children's Hospital, London, UK
| | - Rhian Lakhani
- Paediatric Cardiology and Cardiac Surgery, Evelina London Children's Hospital, London, UK
| | - Shane M Tibby
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - David Anderson
- Cardiothoracic Surgery, Evelina London Children's Hospital, London, UK
| | - Victor Tsang
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Katherine Brown
- Heart and Lung Directorate, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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12
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Surgical and Psychosocial Predictors of Mental Health in Parents of Children With Cardiac Admissions. Ann Thorac Surg 2020; 110:1677-1682. [PMID: 32147414 DOI: 10.1016/j.athoracsur.2020.01.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study investigated factors associated with long-term mental health outcomes of parents of children with a cardiac illness. The objective of the study was to investigate the hypothesis that acute mental health status and psychosocial risk factors (eg, acute stress reactions, quality of life) would be more strongly associated with long-term mental health outcomes than demographic, diagnostic, morphology, or procedure-related factors. METHODS Participants were 31 parents of children who underwent cardiac operations in a pediatric hospital. Acute mental health status, psychosocial risk, demographic information, morphology, and procedure-related data were collected within the first 4 weeks of the child's hospital admission. Mental health outcomes, including symptoms of posttraumatic stress, depression, anxiety, and general stress, were collected at a 2-year follow-up. RESULTS Acute mental health status and psychosocial risk, specifically acute stress reactions, contributed significantly to parent mental health, explaining 44% of the variance in the parent posttraumatic stress scores (P < .001) and 40% in depression scores (P < .001). Morphology and procedure-related factors (eg, prolonged mechanical ventilation) explained a further 12% of the variance in parent posttraumatic stress scores (P = .015) and a further 13% in depression scores (P = .014). No associations were found with demographic factors. CONCLUSIONS Results suggest that acute mental health status is more strongly related to parent mental health outcomes than morphology and procedure-related variables in children undergoing neonatal cardiac operations and that demographic variables are not associated with mental health outcomes.
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13
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Lotto R, Jones I, Seaton SE, Dhannapuneni R, Guerrero R, Lotto A. Congenital Cardiac Surgery and Parental Perception of Risk: A Quantitative Analysis. World J Pediatr Congenit Heart Surg 2019; 10:669-677. [PMID: 31701827 DOI: 10.1177/2150135119872489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Interpretation of risk by parents of children undergoing congenital cardiac surgery is poorly documented. The available evidence highlights a dichotomy where clinicians suggest parents may not grasp the complexity and risk associated with procedures, while some parents suggest risk is unnecessarily overemphasized. AIM To quantify how risk is perceived by parents. METHODS One hundred six parents of children undergoing cardiac surgery were recruited and completed a Likert-type scale from 1 (perceived low risk) to 6 (perceived high risk), at 5 points: arrival at preadmission, post discussion with anethetist/surgeon, day of surgery, discharge from intensive care, and at outpatient follow-up. The surgical sample was stratified according to Risk Adjustment in Congenital Heart Surgery level. ANALYSIS Data were analyzed using Wilcoxon rank tests for differences in distributions of scores and Krippendorff α to examine the level of agreement. RESULTS Median parental risk scores varied over time, with no consistent risk scores observed. Maternal scores were consistently higher than paternal scores at every time point (P < .001). Postoperative complications resulted in a persistent rise in risk perception at follow-up (P < .001). Analysis of parental risk scores and objective measures of surgical risk highlighted poor agreement that was particularly marked at the extremes of risk. CONCLUSIONS Parents perceived higher risk scores than those reported by the clinical team. Mothers reported statistically significantly higher scores than their partners, highlighting potential tensions. In addition, the changing perception of risk over time emphasizes the need for flexible levels of support and information as parents navigate uncertainty.
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Affiliation(s)
- Robyn Lotto
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom
| | - Ian Jones
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom
| | - Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ram Dhannapuneni
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rafael Guerrero
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Attilio Lotto
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom.,Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
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14
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Chang LY, Chiu SN, Wang CC, Weng WC, Chang HY. Parenting stress mediates the association between cyanotic congenital heart disease and internalising problems in children and adolescents. Eur J Cardiovasc Nurs 2019; 19:301-309. [PMID: 31656087 DOI: 10.1177/1474515119881871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children and adolescents with cyanotic congenital heart disease have been found to be at an increased risk of internalising problems. The underlying mechanisms, however, remain uncertain. AIMS To examine the association between cyanotic congenital heart disease and internalising problems and assess whether parenting stress mediates this association. METHOD The study sample was 699 children and adolescents (aged 2-17 years) with congenital heart disease (253 with cyanotic congenital heart disease and 446 with acyanotic congenital heart disease) in Taiwan. The Child Behavior Checklist and the Parenting Stress Index were used to assess internalising problems and parenting stress, respectively. A series of multiple regression models was conducted using the SPSS PROCESS procedure to test the association between types of congenital heart disease and internalising problems and the mediating role of parenting stress. A bootstrapping approach was applied to determine the significance of mediation. RESULTS Compared with acyanotic congenital heart disease, cyanotic congenital heart disease was associated with increased levels of internalising problems (B=2.52, P<0.01), and this association was mediated by parenting stress (B=0.97, 95% bias-corrected bootstrap confidence interval 0.24, 1.75). In particular, parents of children with cyanotic congenital heart disease reported significantly more parenting stress compared with parents of children with acyanotic congenital heart disease (B=4.63, P<0.01), which contributed to elevated levels of internalising problems in the offspring (B=0.21, P<0.001). CONCLUSION Cyanotic congenital heart disease conferred risks for internalising problems in children and adolescents, and this association was mediated by parenting stress. Interventions to decrease internalising problems in children and adolescents with cyanotic congenital heart disease may be more effective by targeting parenting stress.
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Affiliation(s)
- Ling-Yin Chang
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Chia-Ching Wang
- Department of Pediatrics, Far Eastern Memorial Hospital, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
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15
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Biber S, Andonian C, Beckmann J, Ewert P, Freilinger S, Nagdyman N, Kaemmerer H, Oberhoffer R, Pieper L, Neidenbach RC. Current research status on the psychological situation of parents of children with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S369-S376. [PMID: 31737543 DOI: 10.21037/cdt.2019.07.07] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congenital heart diseases (CHD) are a leading cause of morbidity in children with a high impact on the psychological health of parents. Possible short-term and long-term psychological problems among parents are addressed in the current paper. The diagnosis of CHD paired with subsequent surgical and interventional treatment and prolonged hospital stays cause acute psychological distress and can lead to posttraumatic stress disorders (PTSD). As the disease course progresses, the impact on parents' health tends to decrease, but the risk of developing long-term psychological issues remains high. Studies have focused mainly on stress and other distressing symptoms without explicitly addressing the effects of a CHD diagnosis on the family system. Since the social environment may play an important role in parent's life, it may be useful to conduct studies to address these issues. In particular, the psychological situation of the father and the impact of the child's disease on the different dimensions of the father's life, such as parenting skills and influences on the parental relationship, have been largely neglected. Recent research has also disregarded the impact of CHD on siblings of the affected child. Research on chronic diseases in general has shown that the children's age and severity of the disease are related to an increased level of stress. Given the severity of CHD, anxiety and depression were higher in parents with children with more severe conditions. In addition, the results suggest that a positive construction of the parent-child relationship (attachment and bonding) is impaired, especially in mothers. Mothers reported worries and concerns about the challenging tasks they would face after learning about their child's CHD and how they can deal with their child's needs. It has also been shown that the child's illness has a negative impact on the whole family system, including the parent's relationship. Impairments on the parental relationship were perceived differently among mothers and fathers. Thus, there is high need for major changes to be identified, developed and implemented in the psychological care of parents with chronically ill children. So far, research has focused more on the psychological status of parents with chronically ill children, but less research has closely examined the effects of a child's CHD on its parent's mental health even though there is a high demand in additional support. A holistic treatment approach should include professional parental support, especially during children's hospitalization, information on the home care resources and services (especially respite services) and psychological support for parents.
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Affiliation(s)
- Sabina Biber
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Caroline Andonian
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Peter Ewert
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Sebastian Freilinger
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Lars Pieper
- Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Germany
| | - Rhoia Clara Neidenbach
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
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16
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Early Emotional, Behavioural and Social Development of Infants and Young Children with Congenital Heart Disease: A Systematic Review. J Clin Psychol Med Settings 2019; 27:686-703. [PMID: 31506852 DOI: 10.1007/s10880-019-09651-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The experiences of diagnosis of congenital heart disease (CHD), cardiac surgery and hospitalisation(s) are distressing and represent a significant stressor for a child and family, which may impact psychosocial development. This systematic review provides a synthesis of psychosocial outcomes of infants and young children with congenital heart disease who had cardiac surgery early in life. Twenty-eight studies related to infant and young children's psychosocial development, specifically emotional, social and behavioural functioning were identified. Variability was related to methodological factors including differences in study design, varying measurement tools and heterogeneous samples. Despite these limitations, the majority of studies were of high quality. The most common finding was a high prevalence of low-severity emotional and behavioural dysregulation. Young children with severe CHD or comorbid conditions experienced greater impairment, with higher rates of externalising behaviour problems, although internalising behaviour problems were also evident. This review integrates findings from literature in the past 28 years on the psychosocial well-being of infants and young children with CHD and demonstrates a risk for emotional, social and behavioural development difficulty, and, importantly, that symptoms of psychosocial impairment are detectable very early in infancy. We advocate for assessment and monitoring of emotional and behavioural regulation and social development to be routinely conducted from infancy to enable prevention and early intervention.
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17
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Denniss DL, Sholler GF, Costa DSJ, Winlaw DS, Kasparian NA. Need for Routine Screening of Health-Related Quality of Life in Families of Young Children with Complex Congenital Heart Disease. J Pediatr 2019; 205:21-28.e2. [PMID: 30366775 DOI: 10.1016/j.jpeds.2018.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess health-related quality of life (HRQOL) in families of young children with complex congenital heart disease (CHD), and identify the demographic, clinical, and psychosocial factors that place these children and their mothers at greater risk of vulnerability. STUDY DESIGN This cross-sectional study took place from June 2015 to October 2016 at The Sydney Children's Hospitals Network Cardiac Service, Australia. Mothers of a child aged 1-5 years with either single ventricle CHD or CHD requiring neonatal biventricular repair were invited to participate. Eighty-seven mothers completed a suite of validated measures, including the Pediatric Quality of Life Inventory, which assessed the outcomes of child and maternal HRQOL. RESULTS Sixty percent of children with single ventricle CHD and 25% of children with biventricular repair had total Pediatric Quality of Life Inventory scores within the at-risk range. Lower child HRQOL was strongly associated with single ventricle CHD (β = -0.38; P < .001), physical comorbidity (β = -0.32; P = .001), feeding difficulties (β = -0.26; P = .008), and greater maternal psychological stress (β = -0.18; P = .045), accounting for 52% of the variance in child HRQOL. Lower maternal HRQOL was strongly associated with poorer family functioning (β = 0.61; P < .001), greater maternal psychological stress (β = -0.23; P = .004), child physical comorbidity (β = -0.17; P = .01), and a 'difficult' child temperament (β = -0.14; P = .01), accounting for 73% of the variance in maternal HRQOL. CONCLUSIONS Lower HRQOL is common in young children with complex CHD, particularly single ventricle CHD. Several predictors of HRQOL are potentially modifiable, offering possible pathways for prevention and early intervention. Routine screening is a necessary first step toward developing models of care to improve HRQOL in this population.
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Affiliation(s)
- Dominique L Denniss
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia
| | - Gary F Sholler
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, North Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - David S Winlaw
- Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Nadine A Kasparian
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Heart Center for Children, The Sydney Children's Hospitals Network (Westmead and Randwick), Sydney, NSW, Australia.
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18
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Glass TJ, Seed M, Chau V. Congenital Heart Disease. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Sanz JH, Wang J, Berl MM, Armour AC, Cheng YI, Donofrio MT. Executive Function and Psychosocial Quality of Life in School Age Children with Congenital Heart Disease. J Pediatr 2018; 202:63-69. [PMID: 30243535 DOI: 10.1016/j.jpeds.2018.07.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/24/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test a model to predict psychosocial quality of life (QOL) in children with congenital heart disease (CHD) via executive dysfunction. STUDY DESIGN Parents of 91 children with CHD requiring surgery in the first year of life completed questionnaires by mail or as part of their cardiology clinic visit. Latent class analysis identified 2 groups of patients with different likelihoods of executive dysfunction. Select medical and demographic characteristics and executive dysfunction group membership were evaluated as predictors of QOL using structural equation modeling. RESULTS In children with CHD, aortic obstruction, male sex, and premature birth predicted worse executive function, explaining 59% of the variance. Structural equation modeling results indicated that executive dysfunction plays an important mediating role, through which CHD with aortic obstruction, male sex, and premature birth indirectly affect psychosocial QOL. Neurologic abnormalities and single-ventricle CHD did not significantly predict executive dysfunction or QOL. CONCLUSIONS Executive dysfunction is a strong predictor of psychosocial QOL at school age. Select medical and demographic risk factors did not directly predict QOL at school age in CHD; however, aortic obstruction, premature birth, and male sex impacted QOL indirectly by contributing to executive dysfunction. These findings suggest important risk factors for executive dysfunction that can be monitored, allowing for provision of early supports for executive skills development in an effort to improve long term psychosocial QOL in at-risk children with CHD.
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Affiliation(s)
- Jacqueline H Sanz
- Division of Neuropsychology, Children's National Health System, Washington, DC; Department of Psychiatry and Behavioral Sciences at The George Washington University School of Medicine, Washington, DC; Department of Pediatrics at The George Washington University School of Medicine, Washington, DC.
| | - Jichuan Wang
- Biostatistics, Children's National Health System, Washington, DC; Research Professor of Epidemiology and Biostatistics, George Washington University, Washington, DC
| | - Madison M Berl
- Division of Neuropsychology, Children's National Health System, Washington, DC; Department of Psychiatry and Behavioral Sciences at The George Washington University School of Medicine, Washington, DC; Department of Pediatrics at The George Washington University School of Medicine, Washington, DC
| | - Anna C Armour
- Division of Neuropsychology, Children's National Health System, Washington, DC
| | - Yao I Cheng
- Biostatistics, Children's National Health System, Washington, DC
| | - Mary T Donofrio
- Department of Pediatrics at The George Washington University School of Medicine, Washington, DC; Division of Cardiology, Children's National Health System, Washington, DC
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20
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Abstract
Parental stress is a universal experience for parents who have children diagnosed with CHD and has been studied within the context of the child's illness, but not through a broader health disparity lens. This paper provides a thorough synthesis of the current literature on parental stress addressing disparities in parents of children with CHD. Several theories and models from within this literature are described and a new comprehensive framework, the Parental Stress and Resilience in CHD Model, is presented. Future research and clinical implications are discussed.
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21
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22
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Responses of mothers of children with CHD: quality of life, anxiety and depression, parental attitudes, family functionality. Cardiol Young 2017; 27:1748-1754. [PMID: 28651675 DOI: 10.1017/s1047951117001184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction The aim of this study was to evaluate the anxiety and depression status, family functions, parenting attitudes, and quality of life in the mothers of children with CHD. METHOD The study enrolled 120 mothers: 40 of children with cyanotic CHD, 40 of children with non-cyanotic CHD, and 40 of healthy controls. Short Form-36 for quality of life, Hospital Anxiety-Depression Scale for anxiety and depression, Family Assessment Device for the detection of problems affecting family functions, and Parental Attitude Research Instrument for measuring child-rearing attitudes were used in the study. RESULTS Statistically significant decreases were found in the general health standards of mothers of non-cyanotic children (p=0.035) and in the emotional and physical role difficulty of mothers of cyanotic children (p=0.006, p=0.010). When anxiety and depression levels of the parents were examined, the anxiety level of the cyanotic group was found to be significantly higher than that of the other groups (p=0.031). When family behaviours were assessed, there was a statistically significant decrease in role status in the families having a child with cyanotic CHD (p=0.035). In the Parental Attitude Research Instrument test, the husband and wife incompatibility sub-scale was found to be statistically significantly lower in the cyanotic CHD group (p=0.030). CONCLUSION When there is a diseased person in the family, the focus should not be solely on the problems of the patient but also on preventive methods to be implemented in order to protect the mental health of all family members.
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23
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Kaugars A, Shields C, Brosig C. Stress and quality of life among parents of children with congenital heart disease referred for psychological services. CONGENIT HEART DIS 2017; 13:72-78. [DOI: 10.1111/chd.12547] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Astrida Kaugars
- Department of Psychology; Marquette University; Milwaukee Wisconsin, USA
| | - Clarissa Shields
- Department of Psychological Sciences; Kent State University; Kent Ohio, USA
| | - Cheryl Brosig
- Department of Pediatrics; Medical College of Wisconsin, Herma Heart Center, Children's Hospital of Wisconsin; Milwaukee Wisconsin, USA
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24
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Simeone S, Pucciarelli G, Perrone M, Rea T, Gargiulo G, Dell'Angelo G, Guillari A, Comentale G, Palma G, Vosa C. Comparative Analysis: Implementation of a Pre-operative Educational Intervention to Decrease Anxiety Among Parents of Children With Congenital Heart Disease. J Pediatr Nurs 2017; 35:144-148. [PMID: 28131545 DOI: 10.1016/j.pedn.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE The present study evaluated the efficacy of a nursing educational intervention in alleviating the level of parental anxiety in the parents of children who required heart surgery for the first time. DESIGN AND METHODS A comparative study was used to explore the parents of children who had to undergo cardiac surgery. Parents of children were randomized into 2 groups: 1) control group and 2) experimental group or parents that received the educational intervention about PICU stay. RESULT The results of STAY-1 showed that the average anxiety score of group 1 was lower than that of group 2 (63.0 [SD=3.5] vs. 70.4 [SD=2.8]). CONCLUSION In order to decrease levels of parental anxiety and stress prior to paediatric surgery, parents should be adequately informed about planned therapeutic procedures. PRACTICE IMPLICATIONS We speculate that pre-surgery parent education on what to expect before, during and after their child's cardiac surgery may improve parents' knowledge and satisfaction and decrease anxiety.
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Affiliation(s)
- Silvio Simeone
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy.
| | | | - Marco Perrone
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy
| | - Teresa Rea
- Department of Hygiene and Public Health, AOU Federico II, Naples, Italy
| | | | - Grazia Dell'Angelo
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy
| | - Assunta Guillari
- Department of Hygiene and Public Health, AOU Federico II, Naples, Italy
| | | | - Gaetano Palma
- Pediatric Cardiac Surgery, AOU Federico II, Naples, Italy
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25
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Agrawal H, Wright OK, Carberry KE, Sexson Tejtel SK, Mery CM, Molossi S. Family perception of unmet support needs following a diagnosis of congenital coronary anomaly in children: Results of a survey. CONGENIT HEART DIS 2017; 12:721-725. [DOI: 10.1111/chd.12473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Hitesh Agrawal
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Oriana K. Wright
- McGovern Medical School at The University of Texas Health Science Center at Houston; Houston Texas
| | - Kathleen E. Carberry
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- Outcomes & Impact Services; Texas Children's Hospital; Houston Texas
| | - S. Kristen Sexson Tejtel
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Carlos M. Mery
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Silvana Molossi
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
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26
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Ellens REH, Bakula DM, Mullins AJ, Scott Reyes KJ, Austin P, Baskin L, Bernabé K, Cheng EY, Fried A, Frimberger D, Galan D, Gonzalez L, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Mullins LL, Nokoff NJ, Palmer B, Poppas D, Paradis A, Yerkes E, Wisniewski AB, Wolfe-Christensen C. Psychological Adjustment of Parents of Children Born with Atypical Genitalia 1 Year after Genitoplasty. J Urol 2017; 198:914-920. [PMID: 28504212 DOI: 10.1016/j.juro.2017.05.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the psychological adjustment of parents of children born with moderate to severe genital atypia 12 months after their child underwent genitoplasty. MATERIALS AND METHODS Parents were recruited longitudinally from a multicenter collaboration of 10 pediatric hospitals with specialty care for children with disorders/differences of sex development and/or congenital adrenal hyperplasia. Parents completed measures of depressive and anxious symptoms, illness uncertainty, quality of life, posttraumatic stress and decisional regret. RESULTS Compared to levels of distress at baseline (before genitoplasty) and 6 months after genitoplasty, data from 25 mothers and 20 fathers indicated significant improvements in all psychological distress variables. However, a subset of parents continued endorsing clinically relevant distress. Some level of decisional regret was endorsed by 28% of parents, although the specific decision that caused regret was not specified. CONCLUSIONS Overall the majority of parents were coping well 1 year after their child underwent genitoplasty. Level of decisional regret was related to having a bachelor's level of education, increased levels of illness uncertainty preoperatively and persistent illness uncertainty at 12 months after genitoplasty but was unrelated to postoperative complications.
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Affiliation(s)
| | | | | | | | - Paul Austin
- St. Louis Children's Hospital, St. Louis, Missouri
| | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, California
| | - Kerlly Bernabé
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Earl Y Cheng
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Allyson Fried
- Women and Children's Hospital of Buffalo, Buffalo, New York
| | | | - Denise Galan
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Lynette Gonzalez
- University of California San Francisco Medical Center, San Francisco, California
| | | | - Thomas Kolon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Sabrina Meyer
- Women and Children's Hospital of Buffalo, Buffalo, New York
| | - Theresa Meyer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Blake Palmer
- Cook Children's Medical Center, Fort Worth, Texas
| | - Dix Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | | | | | - Cortney Wolfe-Christensen
- Children's Hospital of Michigan, Detroit, Michigan; Cook Children's Medical Center, Fort Worth, Texas
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27
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Woolf-King SE, Anger A, Arnold EA, Weiss SJ, Teitel D. Mental Health Among Parents of Children With Critical Congenital Heart Defects: A Systematic Review. J Am Heart Assoc 2017; 6:JAHA.116.004862. [PMID: 28151402 PMCID: PMC5523775 DOI: 10.1161/jaha.116.004862] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Parents of children with critical congenital heart defects (PCCHDs) may be at high risk for mental health morbidity; however, the literature is not well characterized. Given that compromised parental mental health can lead to long‐term cognitive, health‐related, and behavioral problems in children, a systematic review of this literature could provide informed recommendations for continued research and enhance the care of families of children living with critical congenital heart defects. Methods and Results We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines that resulted in 30 studies on the mental health of PCCHDs. The literature revealed that PCCHDs are at an elevated risk for psychological problems, particularly in the immediate weeks and months following cardiac surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of posttraumatic stress disorder, with over 80% presenting with clinically significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically elevated symptoms of depression and/or anxiety, and 30% to 80% reported experiencing severe psychological distress. There was high variability in measurements used to assess study outcomes, methodological quality, and sociocultural composition of the parents included in the studies. Conclusions There is an urgent need for additional research on the severity, course, persistence, and moderators of these mental health problems over time, and for the development and testing of screening approaches and interventions that can be feasibly delivered in the context of ongoing pediatric cardiac care.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY .,Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexandra Anger
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA.,Department of Pediatrics, Pediatric Heart Center, University of California, San Francisco, San Francisco, CA
| | - Emily A Arnold
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sandra J Weiss
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA
| | - David Teitel
- Department of Pediatrics, Pediatric Heart Center, University of California, San Francisco, San Francisco, CA
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28
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Stonawski V, Vollmer L, Köhler-Jonas N, Rohleder N, Golub Y, Purbojo A, Moll GH, Heinrich H, Cesnjevar RA, Kratz O, Eichler A. Long-term Associations of an Early Corrected Ventricular Septal Defect and Stress Systems of Child and Mother at Primary School Age. Front Pediatr 2017; 5:293. [PMID: 29379779 PMCID: PMC5775274 DOI: 10.3389/fped.2017.00293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/20/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Ventricular septal defect (VSD) is the most common congenital heart defect, with larger VSDs typically being corrected with an open-heart surgery during infancy. Long-term consequences of a VSD-corrective surgery on stress systems of child and mother are still unknown. The aim of the present study is to investigate the associations of an early corrected VSD and diurnal cortisol release of child and mother. METHODS 26 children (12 boys) between 6 and 9 years old, who underwent surgery for an isolated VSD within the first 3 years of life, and their mothers participated in the study. Their diurnal cortisol profiles were compared to a sex-, age-, and socioeconomic status-matched healthy control group. Within the VSD group, associations between cortisol and characteristics of surgery and hospitalization were investigated. Child and mother psychopathological symptoms were considered as a possible interfering mechanism of altered cortisol profiles. RESULTS Diurnal cortisol profiles of children with an early corrected VSD did not differ from those of controls. However, mothers of affected children exhibited higher cortisol levels in the morning (p < 0.001, [Formula: see text]) and a steeper diurnal cortisol slope (p = 0.016, [Formula: see text]) than mothers of healthy children. CONCLUSION Results indicate a favorable development of children with an early corrected VSD, in terms of comparable diurnal cortisol profiles with healthy controls, according to a comparable mother-rated psychopathology. Mothers of affected children reveal altered diurnal cortisol levels, without differences in self-rated psychopathology. This divergence should be clarified in future research.
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Affiliation(s)
- Valeska Stonawski
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Laura Vollmer
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nicola Köhler-Jonas
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yulia Golub
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,kbo-Heckscher-Klinikum, München, Germany
| | - Robert A Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Abstract
OBJECTIVES The objectives of this review are to discuss the scope of neurologic injuries in newborns with congenital heart disease, the mechanisms of injury, including prenatal, pre-, intra-, and postoperative factors, neurodevelopmental outcomes, and therapeutic strategies for the timely intervention and prevention of neurologic injury. DATA SOURCE MEDLINE and PubMed. CONCLUSION At the current time, important research is underway to 1) better understand the developing brain in the fetus with complex congenital heart disease, 2) to identify modifiable risk factors in the operating room and ICU to maximize long-term neurodevelopmental outcomes, and 3) develop strategies to improve family psychosocial health, childhood development, and health-related quality of life following hospital discharge. Crucial in this effort is the identification of an early postoperative surrogate variable with good predictive validity for long-term outcomes. If an appropriate surrogate variable for long-term outcomes can be identified, and measured relatively early after surgical intervention for complex congenital heart disease, reliable clinical trials can be undertaken to improve upon current outcomes.
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30
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Rahimianfar AA, Forouzannia SK, Sarebanhassanabadi M, Dehghani H, Namayandeh SM, Khavary Z, Rahimianfar F, Aghbageri H. Anxiety determinants in mothers of children with congenital heart diseases undergoing cardiac surgery. Adv Biomed Res 2015; 4:255. [PMID: 26918237 PMCID: PMC4746939 DOI: 10.4103/2277-9175.170680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background: The infants with congenital cardiovascular diseases are faced with too much problems in the case of their ongoing life. Mothers’ stress investigation would be important because can receive the stress from his parents. The aim of the following study was determined anxiety in mothers of children undergoing cardiac surgery. Materials and Methods: The present study was conducted by an analytical study on 69 infants’ mothers who were operated due to their cardiovascular abnormalities in Yazd Afshar Hospital (2012). In this study, some demographic information and influential factors were recorded germane to mothers’ stress, including residential location, history of infant hospitalization or congenital disease as well as some questions in the case of stimuli of the hospital environment, family support, economic situation and the mothers’ awareness of their stress. Results: There are statistically significant differences between mothers’ stress and their age (P = 0.03) and infants’ age (P < 0.0001). There are not statically significant differences between mothers’ stress score mean and their educational level (P = 0.75), the infants’ hospitalization history (P = 0.57), the history of congenital of disease in family (P = 0.24) and the family support in infant care (P = 0.08). Conclusion: Those mothers who asserted the stimuli of the hospital environment, infant and its mother support, economic situation and the mothers’ awareness lack of disease and infant status as strong stress-making stimuli enjoy a stress high mean.
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Affiliation(s)
- Ali Akbar Rahimianfar
- Department of Cardiac Surgery, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Khalil Forouzannia
- Department of Cardiac Surgery, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Hamide Dehghani
- Faculty Member of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Syedeh Mahdieh Namayandeh
- Department of Cardiac Surgery, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zohre Khavary
- Faculty Member of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Rahimianfar
- Student of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamid Aghbageri
- Department of English Language and School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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31
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Families of children with congenital heart disease: A literature review. Heart Lung 2015; 44:494-511. [PMID: 26404115 DOI: 10.1016/j.hrtlng.2015.08.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/13/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022]
Abstract
In 2000 and 2002, the National Heart, Lung, and Blood Institute launched two initiatives to encourage treatment innovations and research on children with heart disease and their families. Since then, no systematic reviews have examined the evidence regarding the impacts of having a child with congenital heart disease (CHD) on families. This review synthesized key findings regarding families of children with CHD, critiqued research methods, described what has been done, and provided recommendations for future inquiry. Databases searched included PubMed, CINAHL, Family & Society Studies Worldwide, Women's Studies International, and PsycINFO. The literature search followed the PRISMA guidelines. As a result, ninety-four articles were reviewed. Four major themes were derived: parents' psychological health, family life, parenting challenges, and family-focused interventions. In conclusion, while they found parents having psychological symptoms, researchers did not explore parents' appraisals of what led to their symptoms. Research is needed to explore parents' experiences and expectations.
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Abstract
PURPOSE This study aims to evaluate the health-related quality of life of adolescents with congenital heart disease, describing health-related quality of life according to the diagnosis and severity of congenital heart disease, identified by variables such as the presence of symptoms, surgical interventions, use of medication, and residual lesion. METHODS A cross-sectional study was conducted on 203 adolescents with congenital heart disease attended at the Pediatric Cardiology ambulatory of a reference hospital in Brazil. The Brazilian version of the questionnaire KIDSCREEN-27 was used for the assessment of health-related quality of life. Information related to the congenital heart disease diagnosis and clinical variables were collected from the medical records of the patients. RESULTS There was no statistically significant difference between acyanotic and cyanotic groups, as well as for the different diagnosis of congenital heart disease. A trend for better health-related quality of life in the dimension of Psychological Well-Being (p=0.054) was found in the groups with surgical intervention and use of medication. Adolescents that referred a good general health presented significantly better results in all dimensions of health-related quality of life, except for Autonomy and Parent Relation, than those who presented clinical symptoms (p<0.05). CONCLUSIONS Type of congenital heart disease and initial diagnosis did not seem to affect the perception of health-related quality of life, corroborating findings of several studies. Surgical interventions and the use of medication can improve previous clinical status, and therefore it seems to be beneficial in terms of Psychological Well-Being. The presence of clinical symptoms was the variable that caused the largest impact on the perception of health-related quality of life, possibly because of the impairment they bring to the daily lives of these patients.
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33
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von Rhein M, Kugler J, Liamlahi R, Knirsch W, Latal B, Kaufmann L. Persistence of visuo-constructional and executive deficits in adolescents after open-heart surgery. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:303-310. [PMID: 25462490 DOI: 10.1016/j.ridd.2014.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023]
Abstract
AIM This study assesses whether previously reported performance deficiencies in visuo-constructional and executive functions, using the Rey-Osterrieth Complex Figure Test (ROCFT) in pediatric patients with congenital heart disease (CHD), persist into adolescence. METHODS 53 adolescent CHD patients (mean age 13.7) and 39 healthy controls (mean age 14.1) participated. ROCFT performance was measured by three different scoring methods, focusing either on quantitative (Meyers & Meyers, 1995), qualitative (Wallon & Mesmin, 2009), or both performance aspects (Bernstein & Waber, 1996). Potential confounders (i.e., intelligence and visuomotor integration) and surgery-related risk factors were included in the data analysis. RESULTS Adolescents with CHD demonstrated immature copy and recall approaches on the ROCFT using the qualitative system by Wallon and Mesmin (p<.001). Memory performance was also predicted by Bernstein and Waber scores (p<.03), whereas group differences were not significant according to the other scoring methods. Intelligence and visuomotor skills, but not surgery-related risk factors, were positively correlated with ROCFT performance (each p<.02). Interpretation: Visuoconstructional and executive deficiencies could be found in adolescent patients with CHD. However, not all ROCFT scoring methods were equally apt to detect group differences: especially the qualitative scoring method developed by Wallon and Mesmin seems sufficiently sensitive to detect long-lasting visuo-constructional and executive deficiencies in CHD patients.
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Affiliation(s)
- Michael von Rhein
- Child Development Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Department of Pediatrics, Kantonsspital Winterthur, Brauerstr. 15, 8401 Winterthur, Switzerland.
| | - Julietta Kugler
- Child Development Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Rabia Liamlahi
- Child Development Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich/Children's Reseach Center, Switzerland
| | - Walter Knirsch
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich/Children's Reseach Center, Switzerland; Childrens Research Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland; Childrens Research Center, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Liane Kaufmann
- Department of Psychiatry and Psychotherapy A, General Hospital, Milser Straße 10, 6060 Hall in Tyrol, Austria
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Parental mental health moderates the efficacy of exercise training on health-related quality of life in adolescents with congenital heart disease. Pediatr Cardiol 2015; 36:33-40. [PMID: 25077662 DOI: 10.1007/s00246-014-0961-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 07/02/2014] [Indexed: 01/23/2023]
Abstract
To evaluate the moderating influence of parental variables on changes in health-related quality of life (HRQoL) in adolescents with Tetralogy of Fallot (ToF) or a Fontan circulation after participation in standardized exercise training. A multicenter randomized controlled trail in which 56 patients, aged 10-15, were randomly allocated (stratified by age, gender, and congenital heart disease) to a 12-week period with either: (a) 3 times per week standardized exercise training or (b) care-as-usual (randomization ratio 2:1). Adolescents and their parents filled in online questionnaires at baseline and at 12-week follow-up. In this randomized controlled trail, primary analyses involved influence of parental mental health and parental social support for exercise on changes in the TNO/AZL Child Quality of Life Questionnaire Child Form at follow-up. Secondary analyses concerned comparing levels of parental characteristics with normative data. Compared with controls, adolescents in the exercise group reported a decrease in social functioning when their parents had more anxiety/insomnia or severe depression themselves. Adolescents also reported a decrease in social functioning when their parents showed poorer overall mental health themselves. Parents reported comparable or even better mental health compared with normative data. The effect of a standardized exercise program on HRQoL changes in adolescents with ToF or a Fontan circulation is moderated by parental mental health, more specifically by parental anxiety/insomnia and severe depression. The trial registration number of this article is NTR2731 ( www.trialregister.nl ).
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35
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Are the children and adolescents with congenital heart disease living in Southwestern Ontario really overweight and obese? Cardiol Young 2014; 24:848-53. [PMID: 24067132 DOI: 10.1017/s1047951113001157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the prevalence of overweight and obesity in children with congenital heart disease and compare them with age-matched healthy children in Southwestern Ontario, Canada. METHODS We compared the Center of Disease Control weight and body mass index z-scores of 1080 children, aged 2 to 18 years, who presented to our paediatric cardiology outpatient clinic from 2008 to 2010 for congenital heart disease with 1083 healthy controls. RESULTS In all, 18.2% of the children with congenital heart disease and 20.8% of healthy children were identified to be either overweight or obese. Overall, the weight category distribution had been similar between the congenital heart disease and healthy control groups, as well as between the congenital heart disease subgroups. There was no difference in normal weight and overweight/obese categories between children with congenital heart disease and healthy children. The underweight category, however, showed a significantly higher prevalence in congenital heart disease compared with healthy children (6.8 and 4.5%, respectively, p = 0.03). CONCLUSION The prevalence of overweight/obesity did not differ in children with congenital heart disease compared with age-matched healthy children; however, it is still high (18.2%). Obesity may represent an additional risk factor for the long-term cardiovascular health of congenital heart disease patients aside from the underlying heart defect.
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36
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Wolfe-Christensen C, Fedele DA, Kirk K, Mullins LL, Lakshmanan Y, Wisniewski AB. Caregivers of children with a disorder of sex development: associations between parenting capacities and psychological distress. J Pediatr Urol 2014; 10:538-43. [PMID: 24613141 DOI: 10.1016/j.jpurol.2013.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Caregivers of children with a disorder of sex development (DSD) are at increased risk for maladaptive parenting capacities, such as high levels of parental overprotection and perceived vulnerability of their child, in addition to parenting stress. The current study aims to examine whether there are relationships between these parenting capacities and psychological distress, including depressive and anxious symptoms. PATIENTS AND METHODS Participants included 134 caregivers of 90 children with a DSD. Caregivers completed measures of parental overprotection, perceived vulnerability, parenting stress, anxiety, and depression. RESULTS Hierarchical regression analyses revealed that higher levels of parenting stress were related to more anxious and depressive symptoms in caregivers. Higher levels of perceived vulnerability were related to more anxious symptoms. Levels of parental overprotection were unrelated to anxious or depressive symptoms. CONCLUSIONS There is a relationship between parenting capacities and mental health outcomes in caregivers of children with DSD, although the direction of this relationship is not clear. Given the strong relationships between parenting stress and anxious and depressive symptoms, targeting parenting stress and/or psychological distress in these caregivers could result in better functioning overall.
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Affiliation(s)
- Cortney Wolfe-Christensen
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA.
| | - David A Fedele
- University of Florida, Department of Health and Clinical Psychology, Gainesville, FL, USA
| | - Katherine Kirk
- University of Oklahoma College of Nursing, Oklahoma City, OK, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA
| | - Amy B Wisniewski
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Mussatto KA, Sawin KJ, Schiffman R, Leske J, Simpson P, Marino BS. The importance of self-perceptions to psychosocial adjustment in adolescents with heart disease. J Pediatr Health Care 2014; 28:251-61. [PMID: 23910944 PMCID: PMC4518862 DOI: 10.1016/j.pedhc.2013.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/16/2013] [Accepted: 05/29/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study examined the importance of self-perceptions as determinants of psychosocial adjustment reported by adolescents with heart disease and compared adolescents with heart disease to healthy norms. METHODS Ninety-two adolescents with heart disease from a single Midwestern institution provided reports of self-perceptions (health, self-worth, competence, and importance), internalizing behavior problems (IPs; e.g., anxiety and depression) and externalizing behavior problems (EPs; e.g., attention problems and aggression), and health-related quality of life (HRQOL). Hierarchical linear regression was used to assess the impact of self-perceptions, as well as clinical factors (e.g., illness severity, time since last hospitalization, and medications) and demographic characteristics on outcomes. RESULTS Self-perceptions explained the most variance in behavioral and HRQOL outcomes (R(2)adj = 0.34 for IP, 0.24 for EP, and 0.33 for HRQOL, p < .001). Male gender and lower household income were associated with more behavior problems. Clinical variables were only related to HRQOL. Compared with healthy norms, IPs were significantly more common in male adolescents and HRQOL was lower (p < .001). DISCUSSION Adolescents with heart disease are at risk for internalizing behavior problems and reduced HRQOL; however, positive self-perceptions appear to be protective. Self-perceptions are critical and should be addressed by clinicians.
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Affiliation(s)
| | - Kathleen J. Sawin
- Children’s Hospital of Wisconsin, Milwaukee, WI
- University of Wisconsin – Milwaukee, Milwaukee, WI
| | | | - Jane Leske
- University of Wisconsin – Milwaukee, Milwaukee, WI
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Garcia Guerra G, Joffe AR, Robertson CMT, Atallah J, Alton G, Sauve RS, Dinu IA, Ross DB, Rebeyka IM. Health-related quality of life experienced by children with chromosomal abnormalities and congenital heart defects. Pediatr Cardiol 2014; 35:536-41. [PMID: 24158648 DOI: 10.1007/s00246-013-0820-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
Long-term outcomes are fundamental in advising parents about the potential future of their children with congenital heart disease (CHD). No published reports have described the health-related quality of life (HRQL) experienced by children with chromosomal abnormalities who had surgery in early infancy for CHD. A study was undertaken to assess HRQL among children with chromosomal abnormalities and CHD. The authors hypothesized that these children have a worse HRQL than healthy children or a cohort of children matched for CHD diagnosis. Infants with chromosomal abnormalities undergoing cardiac surgery for CHD at 6 weeks of age or younger at the Stollery Children's Hospital between July 2000 and June 2005 were included in the study. The HRQL of these infants was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales completed by their parents at a 4-year follow-up evaluation. The study compared the scores for 16 children with normative data. The children with chromosomal abnormalities and CHD had significantly lower mean total PedsQL (71.3 vs. 87.3; p < 0.0001), Psychosocial Summary (70.3 vs. 86.1; p < 0.0001), and Physical Summary (74.3 vs. 89.2; p = 0.0006) scores. Compared with the matched children, those with chromosomal abnormalities had a significantly lower median total PedsQL (75.0 vs. 84.6; p = 0.03), Physical Summary (79.5 vs. 96.9; p = 0.007), and School Functioning (68.5 vs. 83.0; p = 0.03) scores. A better understanding of the mechanisms and determinants of HRQL in these children has the potential to yield important implications for clinical practice including clarity for treatment decision making as well as determination of targeted supports and services to meet the needs of these children and their families differentially.
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Affiliation(s)
- Gonzalo Garcia Guerra
- Department of Pediatrics, University of Alberta, 3A3.07 Stollery Children's Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada,
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Law M, Hanna S, Anaby D, Kertoy M, King G, Xu L. Health-related quality of life of children with physical disabilities: a longitudinal study. BMC Pediatr 2014; 14:26. [PMID: 24476085 PMCID: PMC3911963 DOI: 10.1186/1471-2431-14-26] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outcomes of health and rehabilitation services for children and youth with disabilities increasingly include assessments of health-related quality of life (HRQoL). The purpose of this research was to 1) describe overall patterns of HRQoL, 2) examine changes in parent's perceptions of child's HRQoL across 18 months and 3) explore factors that predict these changes. METHODS Participants in this study included 427 parents of children (229 boys and 198 girls) with a physically-based disability between the ages of 6 to 14 years. The Child Health Questionnaire (CHQ) was administered three times, at nine month intervals. Comparisons to the CHQ normative data were analyzed at Time 1 using t-tests, and change over time was examined using linear mixed-effects models. Possible predictors were modeled: 1) child's factors measured by the Activities Scale for Kids, Strengths and Difficulties Questionnaire, and general health measured by SF-36, 2) family characteristics measured by the Impact on Family Scale and 3) environmental barriers measured by the Craig Hospital Inventory of Environmental Factors. RESULTS CHQ scores of the study's participants demonstrated significantly lower summary scores from the normative sample for both CHQ Physical and Psychosocial summary scores. On average, children did not change significantly over time for physical summary scores. There was an average increase in psychosocial health that was statistically significant, but small. However, there was evidence of heterogeneity among children. Environmental barriers, behavioral difficulties, family functioning/impact, general health and child physical functioning had negative and significant associations with physical QoL at baseline. Change in physical QoL scores over time was dependent on children's behavioral difficulties, family functioning and environmental barriers. Environmental barriers, behavioral difficulties, family functioning/impact and general health had significant associations with psychosocial scores at baseline, but none served as predictors of change over time. CONCLUSIONS Children with physical disabilities differ from the normative group on parent ratings of their physical and psychosocial health. While there was little average change in CHQ scores over 18 months, there is evidence of heterogeneity among children. Factors such as environmental barriers, family functioning/impact, child physical functioning and behavioral difficulties and general health significantly influence QoL scores as measured by the CHQ.
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Affiliation(s)
- Mary Law
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
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Bertoletti J, Marx GC, Hattge Júnior SP, Pellanda LC. Quality of life and congenital heart disease in childhood and adolescence. Arq Bras Cardiol 2013; 102:192-8. [PMID: 24676375 PMCID: PMC3987336 DOI: 10.5935/abc.20130244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/26/2013] [Indexed: 01/09/2023] Open
Abstract
Advances in cardiac surgery techniques and early diagnosis have enabled the increased
survival of individuals with congenital heart disease. The investigation of the
quality of life in children and adolescents with congenital heart disease provides
complementary information to clinical data that can assist in decision making on the
part of health professionals. Although many studies have been conducted to
investigate the quality of life of children and adolescents with congenital heart
disease, the results prove to be contradictory; while some studies show that
congenital heart disease can impact the quality of life, others describe a better
perception of quality of life among children and adolescents who suffer from the
disease when compared with healthy control subjects. The purpose of this study is to
review the literature on the assessment of health related quality of life in children
and adolescents with congenital heart disease, in order to systematize the existing
knowledge on this topic today. It is observed that research seeks to investigate
aspects of personality in cardiac patients, their coping strategies used and
perceived social support, aiming at better understanding the association of these
variables with the level of quality of life in this population.
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Affiliation(s)
- Juliana Bertoletti
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Porto Alegre, RS, Brasil
| | | | | | - Lucia Campos Pellanda
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Porto Alegre, RS, Brasil
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Kasparian NA, Fidock B, Sholler GF, Camphausen C, Murphy DN, Cooper SG, Kaul R, Jones O, Winlaw DS, Kirk EP. Parents’ perceptions of genetics services for congenital heart disease: the role of demographic, clinical, and psychological factors in determining service attendance. Genet Med 2013; 16:460-8. [DOI: 10.1038/gim.2013.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022] Open
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Behaviour problems in adolescents with cardiac disease: an exploratory study in a paediatric cardiology outpatient clinic. Cardiol Young 2013; 23:368-76. [PMID: 22995528 DOI: 10.1017/s1047951112001242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To assess behavioural problems in adolescents with congenital and acquired heart disease in comparison with healthy controls. The perception of behavioural problems by the patients' parents was also assessed and compared. METHODS A cross-sectional study was carried out in 130 adolescents with congenital and acquired heart disease and 246 healthy controls. The second part of the Youth Self-Report was applied to the patients and controls, and the Child Behavior Checklist to the patients' parents. RESULTS Male patients showed significantly fewer behavioural problems compared with male controls. No significant difference was found in the female gender. Healthy male adolescents scored significantly higher in the Internalising, Externalising, and in the Total Problems scales. Patients scored significantly higher only on the Social Problems subscale. Female patients in middle and late adolescence and male patients in early adolescence displayed more problems. No significant difference was found between the diagnostic groups. Operated patients did not differ from the non-operated ones. Patients scored significantly lower than did their parents. CONCLUSIONS Male adolescents with cardiac disease reported fewer behavioural problems when compared with healthy controls, but no difference was observed in the female gender. Patients also reported fewer behavioural problems than did their parents. Adolescents with cardiac disease scored higher than did controls only on the Social Problems subscale. Analysing the patients' behavioural profile, female patients in middle and late adolescence and male patients in early adolescence were the most problematic ones. No difference was observed between the diagnostic groups, nor between operated and non-operated patients.
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Abstract
Childhood cardiac arrhythmias may have a long-lasting impact on a family and typically require long-term medical follow-up. Whereas some arrhythmias are benign, others can be life threatening and require significant medical care. As with many chronic illnesses, it is important to study the potential psychosocial effects of childhood arrhythmias and how they may impact a child's quality of life. The purpose of this study was to create a quality of life measure specific to childhood arrhythmias and to describe the current psychosocial functioning of this population. A total of 46 families participated in a one-time paper and pencil assessment during their regularly scheduled clinic visits. Results indicated promise for the validity and reliability of this new measure. Children in the current sample also demonstrated a high degree of resiliency. Additional analyses with larger samples will be needed to verify the psychometric properties of this measure. Overall, the high functioning of many of these children despite medical trauma is promising. Future studies should consider using some screening measures to decide which children may be most in need of intervention.
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Brossard-Racine M, Waknin J, Shikako-Thomas K, Shevell M, Poulin C, Lach L, Law M, Schmitz N, Majnemer A. Behavioral difficulties in adolescents with cerebral palsy. J Child Neurol 2013; 28:27-33. [PMID: 23076425 DOI: 10.1177/0883073812461942] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Behavioral problems are common in children with cerebral palsy; however, little is known about the persistence of these difficulties during adolescence. This study aimed to describe the nature and frequency of behavioral difficulties in adolescents with cerebral palsy and to explore associated factors. Parents of the participants completed the Strengths and Difficulties Questionnaire. Participants' motor and cognitive abilities, functional status, as well as parental stress were evaluated. Overall, the study enrolled 160 adolescents with cerebral palsy (65 girls, mean age 15.4 ± 2.17 years). Behavioral difficulties were present in 36.9% of the adolescents, with peer problems the most frequently reported (61.9%). Prosocial behaviors were associated with better function (r = 0.24-0.65) whereas hyperactive symptoms were associated with greater limitations (r = -0.19 to -0.55). Weak associations were found between parental stress and externalized problems (r = 0.22-0.24). Behavioral difficulties remained frequent in adolescents with cerebral palsy, particularly in those with greater functional limitations.
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Affiliation(s)
- Marie Brossard-Racine
- Advanced Paediatric Brain Imaging Research Laboratory, Division of Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC, USA
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Wolfe-Christensen C, Fedele DA, Kirk K, Phillips TM, Mazur T, Mullins LL, Chernausek SD, Lakshmanan Y, Wisniewski AB. Degree of external genital malformation at birth in children with a disorder of sex development and subsequent caregiver distress. J Urol 2012; 188:1596-600. [PMID: 22910249 DOI: 10.1016/j.juro.2012.02.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Indexed: 01/28/2023]
Abstract
PURPOSE We determined whether the degree of genital malformation at birth in children with a disorder of sex development is related to subsequent caregiver distress, specifically symptoms of depression and anxiety. MATERIALS AND METHODS A total of 66 caregivers of children with disorders of sex development were recruited from 3 centers that specialize in disorders of sex development medicine. The caregivers completed the Beck Depression Inventory, 2nd Edition and the Beck Anxiety Inventory. The child's Prader score at birth was determined by the child's treating pediatric endocrinologist and/or pediatric urologist at each institution. RESULTS Results from the current study revealed that for caregivers of male children, under masculinization of the child's genitals at birth was significantly related to higher levels of subsequent caregiver depression. In contrast, over masculinization of the genitals of female children at birth was unrelated to caregiver depression or anxiety. CONCLUSIONS These findings suggest that caregivers of male children with disorders of sex development may be at increased risk for psychological distress and could benefit from family based psychosocial interventions.
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Quality of life 4 years after complex heart surgery in infancy. J Thorac Cardiovasc Surg 2012; 145:482-488.e2. [PMID: 22507845 DOI: 10.1016/j.jtcvs.2012.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 03/09/2012] [Accepted: 03/19/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the health-related quality of life at 4 years of age in children who had undergone cardiac surgery for congenital heart disease in early infancy. METHODS A prospective cohort study of infants undergoing cardiac surgery at 6 weeks of age or younger from July 2000 to June 2005 at the Stollery Children's Hospital. The quality of life was assessed using the Pediatric Quality of Life Inventory, version 4.0, generic core scales, and compared with normative values for the same age. The association between the perioperative variables and health-related quality of life was explored. RESULTS A total of 242 infants underwent complex heart surgery during the study period. Of the 166 eligible survivors, 130 were included. No significant differences were present between the children with single ventricle versus biventricular repairs, except for lower physical health summary scores in the single ventricle patients (P = .007). Compared with the normative data, the children with biventricular repair had lower total Pediatric Quality of Life Inventory, version 4.0, scores (P = .001) and psychosocial health summary scores (P < .001). The children with single ventricle repair also had lower physical health summary scores (P = .003). Older age at surgery and markers of postoperative low cardiac output syndrome were associated with worse health-related quality of life, and greater socioeconomic status was associated with better quality of life. CONCLUSIONS At 4 years of age, health-related quality of life was significantly lower in children who had undergone surgery for congenital heart disease in early infancy. An association was found between age at surgery and postoperative low cardiac output and socioeconomic status and quality of life.
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Facets of parenting a child with hypoplastic left heart syndrome. Nurs Res Pract 2012; 2012:714178. [PMID: 22548161 PMCID: PMC3324165 DOI: 10.1155/2012/714178] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 01/04/2012] [Indexed: 12/28/2022] Open
Abstract
The purpose of the study was to conceptualize the needs of parents of young children with hypoplastic left heart syndrome (HLHS) to provide a theoretical framework to inform the development of future parent interventions. Participants were parents and grandparents (n = 53) of 15 young children who had undergone the Sano surgical approach for HLHS. Analysis of recorded and transcribed single interviews with each participant was done as directed by interpretive description methodology. A model of five facets of parenting was conceptualized. These included survival parenting, “hands-off” parenting, expert parenting, uncertain parenting, and supported parenting. The facets of parenting delineated through this study provide a theoretical framework that can be used to guide the development and evaluation of interventions for parents of children with complex congenital heart disease and potentially other life-threatening conditions. Each facet constitutes a critical component for educational or psychosocial intervention for parents.
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Solberg Ø, Grønning Dale MT, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Trajectories of maternal mental health: a prospective study of mothers of infants with congenital heart defects from pregnancy to 36 months postpartum. J Pediatr Psychol 2012; 37:687-96. [PMID: 22408057 DOI: 10.1093/jpepsy/jss044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To chart mothers' trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants' congenital heart defects (CHD) and compromised maternal mental health. METHODS Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. RESULTS Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. CONCLUSIONS Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distress.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway.
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Brossard-Racine M, Hall N, Majnemer A, Shevell MI, Law M, Poulin C, Rosenbaum P. Behavioural problems in school age children with cerebral palsy. Eur J Paediatr Neurol 2012; 16:35-41. [PMID: 22036311 DOI: 10.1016/j.ejpn.2011.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 09/20/2011] [Accepted: 10/03/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Although behavioural problems are frequent in children with Cerebral Palsy (CP), the exact nature of these difficulties and their relationship with intrinsic or extrinsic factors are just beginning to be explored. AIM To describe and characterize behavioural problems in children with CP and to determine the nature of any relationships with child and family characteristics. METHODS In this cross-sectional study, children with CP between 6 and 12 years of age were recruited. Children were assessed using the Leiter Intelligence Test, the Gross Motor Function Measure, the Strengths and Difficulties Questionnaire (SDQ), the Vineland Adaptive Behavior Scales and questionnaires on demographic factors. Parents' level of stress was measured with the Parenting Stress Index. RESULTS Seventy-six parents completed the SDQ. Using the Total Difficulties Scores, 39.4% of the sample scored in the borderline to clinically abnormal range. Peer problems were the most common (55.3%). High parental stress was consistently associated with behavioural difficulties across all domains of the SDQ. Not surprisingly, better socialization skills and a lower parental stress were correlated with more positive behaviours. CONCLUSION Behavioural difficulties are common in children with CP and appear not to be associated with socio-demographic variables and physical and cognitive characteristics. These difficulties are an important correlate of parental distress. This study emphasizes the need to recognize and address behavioural difficulties that may arise so as to optimize the health and well-being of children with CP and their families.
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Affiliation(s)
- Marie Brossard-Racine
- School of Physical & Occupational Therapy McGill University Health Centre, QC, Canada
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Prevalence of obesity among patients with congenital and acquired heart disease. Pediatr Cardiol 2012; 33:8-14. [PMID: 21892630 DOI: 10.1007/s00246-011-0049-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022]
Abstract
Overweight and obesity rates have risen dramatically in the United States, with subsequent detrimental comorbidity risks. The rates for obesity among children with congenital and acquired heart disease have rarely been reported. A retrospective cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with heart disease and to identify subgroups at increased risk. A total of 795 cases were identified from a chart review of patients presenting to an urban center's Pediatric Cardiology Program between 1 January and 31 December 2006. A body mass index (BMI) at the 85th percentile or higher was defined as overweight, and a BMI at the 95th percentile or higher was defined as obese. Subjects with comorbidities affecting body habitus were excluded from the study. Overall, overweight and obesity rates were similar to national data. No significant differences in overweight or obesity rates were detected between heart disease and non-heart disease groups (P = 0.50). According to multivariate analysis, Hispanic ethnicity and male gender were the only predictors of obesity. This study shows that children with heart disease are not immune to the common predictors of obesity such as gender and ethnicity and that the future care of children with heart disease should include general discussions about the risks for obesity.
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