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Glinianaia SV, Tan J, Morris JK, Brigden J, Evans HER, Loane M, Neville AJ, Rankin J. Academic achievement at ages 11 and 16 in children born with congenital anomalies in England: A multi-registry linked cohort study. Paediatr Perinat Epidemiol 2024; 38:411-425. [PMID: 38318667 DOI: 10.1111/ppe.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Children born with major congenital anomalies (CAs) have lower academic achievement compared with their peers, but the existing evidence is restricted to a number of specific CAs. OBJECTIVES To investigate academic outcomes at ages 11 and 16 in children with major isolated structural CAs and children with Down or Turner syndromes. METHODS This population-based cohort study linked data on approximately 11,000 school-aged children born with major CAs in 1994-2004 registered by four regional CA registries in England with education data from the National Pupil Database (NPD). The comparison group was a random sample of children without major CAs from the background population recorded in the NPD that were frequency matched (5:1) to children with CAs by birth year, sex and geographical area. RESULTS Overall, 71.9%, 73.0% and 80.9% of children with isolated structural CAs achieved the expected attainment level at age 11 compared to 78.3%, 80.6% and 86.7% of the comparison group in English language, Mathematics and Science, respectively. Children with nervous system CAs as a whole had the lowest proportion who achieved the expected attainment at age 11. At age 16, 46.9% of children with CAs achieved the expected level compared to 52.5% of their peers. Major CAs were associated with being up to 9% (95% confidence interval [CI] 8%, 11%) and 12% (95% CI 9%, 14%) less likely to achieve expected levels at ages 11 and 16, respectively, after adjustment for socioeconomic deprivation. CONCLUSIONS Although many children with isolated CAs achieved the expected academic level at ages 11 and 16, they were at higher risk of underachievement compared to their peers. These stark yet cautiously encouraging results are important for counselling parents of children with specific CAs and also highlight the possible need for special education support to reduce potential academic difficulties.
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Affiliation(s)
- Svetlana V Glinianaia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Joachim Tan
- Population Health Research Institute, St George's, University of London, London, UK
- NIHR GOSH Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jo Brigden
- Population Health Research Institute, St George's, University of London, London, UK
| | - Hannah E R Evans
- Population Health Research Institute, St George's, University of London, London, UK
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Belfast, UK
| | - Amanda J Neville
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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2
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Fleming M, Athanasopoulos P, Mackay DF, Pell JP. Educational outcomes among children with congenital heart disease compared to peers: a Scotland-wide record-linkage study of 715,850 schoolchildren. BMC Pediatr 2024; 24:405. [PMID: 38909207 PMCID: PMC11193247 DOI: 10.1186/s12887-024-04848-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/22/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Nine in every thousand children born in the United Kingdom have congenital heart disease, and 250,000 adults are living with the condition. This study aims to investigate the associations between congenital heart disease and educational outcomes among school-aged children in Scotland. METHODS Routine health and education databases were linked to produce a cohort of all singleton children born in Scotland and attending a local authority run primary, secondary, or special school in Scotland at some point between 2009 and 2013. Children with congenital heart disease within this cohort were compared with children unaffected by congenital conditions. Outcomes investigated were special educational need (SEN), absenteeism, exclusion, academic attainment, and unemployment. All analyses were adjusted for sociodemographic and maternity confounders. Absenteeism was investigated as a mediating factor in the associations with attainment and unemployment. RESULTS Of the 715,850 children, 6,295 (0.9%) had congenital heart disease and 4,412 (6.1%) had isolated congenital heart disease. Congenital heart disease and isolated congenital heart disease were both significantly associated with subsequent special educational need (OR 3.45, 95% CI 3.26-3.65, p < 0.001 and OR 1.98, 95% CI 1.84-2.13, p < 0.001 respectively), absenteeism (IRR 1.13, 95% CI 1.10-1.16, p < 0.001 and IRR 1.10, 95% CI 1.06-1.13, p < 0.001 respectively), and low academic attainment (OR 1.69, 95% CI 1.39-2.07, p < 0.001 and OR 1.35, 95% CI 1.07-1.69, p = 0.011 respectively). Neither congenital heart disease nor isolated congenital heart disease were associated with school exclusion. Only congenital heart disease (OR 1.21, 95% CI 1.03-1.42, p = 0.022) but not isolated congenital heart disease was associated with unemployment. When days absent were included in the analyses investigating attainment and unemployment, the conclusions were not altered. CONCLUSION Children with congenital heart disease have greater special educational need, lower school attendance, attain lower examination grades and have greater unemployment compared to peers. In addition to healthcare support, affected children need educational support to avoid additional impact on their long-term wellbeing.
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Affiliation(s)
- Michael Fleming
- School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK.
| | - Paul Athanasopoulos
- School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Daniel F Mackay
- School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
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Sood E, Newburger JW, Anixt JS, Cassidy AR, Jackson JL, Jonas RA, Lisanti AJ, Lopez KN, Peyvandi S, Marino BS. Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e997-e1022. [PMID: 38385268 DOI: 10.1161/cir.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.
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Wands ZE, Cave DGW, Cromie K, Hough A, Johnson K, Mon-Williams M, Feltbower RG, Glaser AW. Early educational attainment in children with major congenital anomaly in the UK. Arch Dis Child 2024; 109:326-333. [PMID: 38262694 DOI: 10.1136/archdischild-2023-326471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To describe early educational attainment and special educational needs (SEN) provision in children with major congenital anomaly (CA) compared with peers. DESIGN Analysis of educational data linked to the ongoing Born in Bradford cohort study. Confounders were identified via causal inference methods and multivariable logistic regression performed. SETTING Children born in Bradford Royal Infirmary (BRI), West Yorkshire. PATIENTS All women planning to give birth at BRI and attending antenatal clinic from March 2007 to December 2010 were eligible. 12 453 women with 13 776 pregnancies (>80% of those attending) were recruited. Records of 555 children with major CA and 11 188 without were linked to primary education records. OUTCOMES Key Stage 1 (KS1) attainment at age 6-7 years in Maths, Reading, Writing and Science. SEN provision from age 4 to 7 years. RESULTS 41% of children with major CA received SEN provision (compared with 14% without), and 48% performed below expected standards in at least one KS1 domain (compared with 29% without). The adjusted odds of children with CA receiving SEN provision and failing to achieve the expected standard at KS1 were, respectively, 4.30 (95% CI 3.49 to 5.31) and 3.06 (95% CI 2.47 to 3.79) times greater than their peers. Those with genetic, heart, neurological, urinary, gastrointestinal and limb anomalies had significantly poorer academic achievement. CONCLUSIONS These novel results demonstrate that poor educational attainment extends to children with urinary, limb and gastrointestinal CAs. We demonstrate the need for collaboration between health and education services to assess and support children with major CA, so every CA survivor can maximise their potential.
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Affiliation(s)
- Zoë E Wands
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel G W Cave
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kirsten Cromie
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
| | - Amy Hough
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Kathryn Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- National Congenital Anomaly and Rare Disease Registration Service, London, UK
| | - Mark Mon-Williams
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Adam W Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Verrall CE, Tran DL, Kasparian NA, Williams T, Oxenham V, Ayer J, Celermajer DS, Cordina RL. Cognitive Functioning and Psychosocial Outcomes in Adults with Complex Congenital Heart Disease: A Cross-sectional Pilot Study. Pediatr Cardiol 2024; 45:529-543. [PMID: 38261061 PMCID: PMC10891231 DOI: 10.1007/s00246-023-03376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
Adults with complex congenital heart disease (CHD) are at risk for cognitive dysfunction. However, associations between cognitive dysfunction and psychosocial outcomes are poorly defined. Between June and November 2022, we prospectively recruited 39 adults with complex CHD who completed a computerized cognitive assessment (Cogstate) and validated psychosocial scales measuring psychological distress, health-related quality of life (HRQOL), and resilience. Participants had a mean age of 36.4 ± 11.2 years. Over half (62%) were women, most (79%) had complex biventricular CHD, and 21% had Fontan physiology. Prevalence of cognitive dysfunction was greatest in the domains of attention (29%), working memory (25%), and psychomotor speed (21%). Adjusting for age and sex, Pearson partial correlations between Cogstate z-scores and self-reported cognitive problems were small. Participants who lived in the most disadvantaged areas and those with a below-average annual household income had lower global cognitive z-scores (p = 0.02 and p = 0.03, respectively). Two-thirds (64%) reported elevated symptoms of depression, anxiety, and/or stress. Small correlations were observed between psychological distress and cognitive performance. Greater resilience was associated with lower psychological distress (r ≥ -0.5, p < 0.001) and higher HRQOL (r = 0.33, p = 0.02). Our findings demonstrate that adults with complex CHD have a high risk of cognitive dysfunction, though may not recognize or report their cognitive challenges. Lower socioeconomic status may be an indicator for those at risk of poorer cognitive functioning. Psychological distress is common though may not be a strong correlate of performance-based cognitive functioning. Formal cognitive evaluation in this patient population is essential. Optimizing resilience may be a protective strategy to minimize psychological distress and bolster HRQOL.
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Affiliation(s)
- Charlotte E Verrall
- The University of Sydney School of Medicine, Sydney, NSW, Australia.
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Derek L Tran
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tracey Williams
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Vincent Oxenham
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Julian Ayer
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David S Celermajer
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rachael L Cordina
- The University of Sydney School of Medicine, Sydney, NSW, Australia
- Clinical Research Group, Heart Research Institute, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Peterson JK, Gentry-Russell N, Francis L. School Readiness Among Children With Congenital Heart Disease. THE JOURNAL OF SCHOOL HEALTH 2024; 94:279-281. [PMID: 37345223 DOI: 10.1111/josh.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Affiliation(s)
| | | | - Lucine Francis
- Johns Hopkins University School of Nursing, Baltimore, MD
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7
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Mamasoula C, Pennington L, Adesanya AM, Rankin J. A systematic review and meta-analysis of school and cognitive function domains of health-related quality of life measures for children and young adults with congenital heart disease. Birth Defects Res 2024; 116:e2275. [PMID: 38014517 DOI: 10.1002/bdr2.2275] [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: 04/05/2023] [Revised: 07/31/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Research on cognitive and school functioning domains of health-related quality of life (HRQOL) for children and adolescents with congenital heart disease (CHD) presents inconsistencies. OBJECTIVES To summarize and synthesize data on school and cognitive function domains of HRQOL for children and young people (CYP) with CHD. METHODS Five electronic databases MEDLINE, Scopus, PsycINFO, EMBASE, ERI, and citations were systematically searched. We included original-research articles reporting the cognitive and school function domains of HRQOL for children and young people with CHD (child and parent reports included). Both fixed and random-effects meta-analyses were performed to estimate pooled mean test scores for cognitive and school function. A total of 34 studies met our inclusion criteria and were synthesized narratively, 17 studies were included in formal meta-analyses. RESULTS Self-reported cognitive function was lower for children and young people with CHD than healthy controls (SMD -0.28 (-0.42, -0.15)). Parental reports demonstrated similar results to self-reports (SMD -0.54 (-0.91, -0.18)). School function was lower in children and young people with CHD compared with healthy controls in self-reported (SMD -0.30 (-0.48, -0.13)) and parent reported HRQOL (SMD -0.49 (0.64, -0.36)). Self-reported school function domain scores were lower for young (<8 years) (SMD -0.65 (-1.32, 0.03)) and older children (8-18 years) (SMD -0.25 (-0.47, -0.03)) with CHD than their peers. Similarly, parents reported lower school function domain scores for young (<8 years) (SMD -0.68 (-1.29, -0.07)) and older (8-18 years) (SMD -0.46 (-068, -0.25)) children with CHD than typically developing peers. CONCLUSION Children born with CHD may experience lower cognitive and school function HRQOL scores than healthy controls (self and proxy-report). This is consistent with a subgroup meta-analysis of young (<8 years) and older (8 years old or more) children with CHD reporting lower school function scores compared to controls.
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Affiliation(s)
| | - Lindsay Pennington
- Population Health Science Institute, Newcastle University, Newcastle, UK
| | | | - Judith Rankin
- Population Health Science Institute, Newcastle University, Newcastle, UK
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8
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Roustaei Z, Heino A, Kiuru-Kuhlefelt S, Morris JK, Glinianaia SV, Garne E, Loane M, Rankin J, Gissler M. Educational achievement of children with selected major congenital anomalies and associated factors: a Finnish registry-based study. Eur J Public Health 2023; 33:1027-1034. [PMID: 37594898 PMCID: PMC10710322 DOI: 10.1093/eurpub/ckad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Children with major congenital anomalies may be at risk of poor educational outcomes. We aimed to evaluate the educational achievement of children born with major congenital anomalies compared with children without major congenital anomalies in relation to sociodemographic factors. METHODS We performed a registry-based study including 401 544 children in Finland, graduates of the compulsory school who applied to secondary education. We used health data from the Finnish Register of Congenital Malformations for children born from 1995 to 2002 linked with education data from the Finnish Ministry of Education and Culture. We used generalized linear regression to compare the mean grade differences of children with specific major congenital anomalies and 'All anomalies' subgroup (major congenital anomalies, chromosomal syndromes, and multiple anomalies) with reference children. RESULTS Children with major congenital anomalies were less likely to apply for further education than reference children (88.0% vs. 96.8%; odds ratio = 4.13; 95% confidence interval, 3.92-4.36). For most non-chromosomal congenital anomalies, children born with congenital anomalies had similar educational achievement to the reference children. For the 'All anomalies' subgroup, children with congenital anomalies had lower educational achievement than reference children. Among children with congenital anomalies, male sex, lower maternal educational levels and younger maternal age were associated with lower educational achievement. CONCLUSIONS For children applying to further education, most non-chromosomal congenital anomalies were not associated with lower educational achievement. Nevertheless, efforts are needed to improve educational achievement in children with major congenital anomalies associated with maternal sociodemographic background.
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Affiliation(s)
- Zahra Roustaei
- Department of Health Sciences, University of Helsinki, Helsinki, Finland
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sonja Kiuru-Kuhlefelt
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | | | - Ester Garne
- Paediatric Department, Hospital Lillebælt, Kolding, Denmark
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Belfast, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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9
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Delgado C, Ullery MA, Zeng G, Simpson EA, Tanner JP, Kirby RS, Duclos C, Lowry J, Salemi JL. Elevated risk for developmental disabilities in children with congenital heart defects. Birth Defects Res 2023; 115:1708-1722. [PMID: 37681320 DOI: 10.1002/bdr2.2246] [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: 05/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level. METHODS Statewide birth, birth defects, and preschool developmental disability records were integrated. The final sample included 1,966,585 children (51.0% male). Children were grouped by type(s) of CHD: critical CHD, noncritical CHD, atrial septal defect, or no major birth defects (groups were mutually exclusive). RESULTS Children with a CHD (any type) were at increased risk for developmental disability (any type) (RR 2.08, 95% CI 2.03-2.14, P < .001). Children in the critical CHD, noncritical CHD, and atrial septal defect groups were at increased risk for developmental delay, intellectual disability, language impairment, other health impairment, and any disability. Children in the atrial septal defect group were at increased risk for autism spectrum disorder and speech impairment. For all CHD groups, risk was greatest for other health impairment and intellectual disability. CONCLUSIONS Increased risk for developmental disabilities was identified for children with less severe CHDs as well as for children with more severe (critical) CHDs. All children with CHDs should be closely monitored so that appropriate interventions can be initiated as early as possible to maximize learning outcomes.
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Affiliation(s)
- Christine Delgado
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Mary Anne Ullery
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Guangyu Zeng
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | | | - J P Tanner
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Chris Duclos
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Joseph Lowry
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Jason L Salemi
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
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10
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Spillmann R, Polentarutti S, Ehrler M, Kretschmar O, Wehrle FM, Latal B. Congenital heart disease in school-aged children: Cognition, education, and participation in leisure activities. Pediatr Res 2023; 94:1523-1529. [PMID: 34853428 PMCID: PMC10589091 DOI: 10.1038/s41390-021-01853-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/26/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with congenital heart disease (CHD) are at risk for neurodevelopmental deficits. This study aimed to investigate the impact of cognitive deficits on educational outcome and participation in leisure activities. METHODS A prospective cohort of 134 children with CHD who underwent cardiopulmonary bypass surgery (CPB) was examined at 10 years of age. IQ was assessed with the WISC-IV and executive functions with the BRIEF (parent- and teacher-report). Parents reported on type and level of education and educational support, and leisure activity participation. Ordinal regression analyses assessed the association between cognitive deficits and educational outcome and participation. RESULTS Total IQ (P = 0.023), working memory (P < 0.001), processing speed (P = 0.008), and teacher-reported metacognition (P = 0.022) were lower than norms. Regular school was attended by 82.4% of children with CHD compared to 97% of the general Swiss population (P < 0.001). Seventy-five percent of children participated in leisure activities. Lower total IQ and teacher-rated global executive functions were associated with more educational support and lower IQ was associated with less participation. CONCLUSION As school-aged children with CHD experience cognitive deficits, follow-up is required to provide optimal support with regard to educational outcome and participation in leisure activities. IMPACT Contemporary cohorts of children with congenital heart disease undergoing cardiopulmonary bypass surgery remain at increased risk for cognitive deficits. Cognitive deficits affect educational outcome and leisure activities. These findings underline the importance of early detection of cognitive deficits and recommend support with respect to cognitive functioning.
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Affiliation(s)
- Rebecca Spillmann
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Susanne Polentarutti
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Department of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Flavia M Wehrle
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Neonatology and Intensive Care, 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.
- University of Zurich, Zurich, Switzerland.
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11
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Brossard-Racine M, Majnemer A. Identifying developmental challenges of youth with congenital heart defects: A patient-oriented perspective. Child Care Health Dev 2023; 49:258-267. [PMID: 35945137 DOI: 10.1111/cch.13037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with congenital heart disease (CHD) are at high risk for a range of developmental impairments that become evident at different times across childhood and adolescence. This study aimed to explore perspectives of youth with CHD with respect to their developmental follow-up across childhood. METHODS Interpretive description was used as a methodological approach for this qualitative study. Youth aged 12-22 years with CHD requiring open-heart surgery before 2 years of age and who had received health services in Canada since birth were enrolled. RESULTS Ten youth with CHD, two males and eight females, aged 13-22 years (mean 19.8) participated in this study. With higher social and academic demands as well as increased level of autonomy associated with older age, some youth faced new challenges that they had not encountered as children. Youth with CHD identified four aspects of the continuum of care as needing to be changed to better respond to their needs. First, the format of developmental follow-up needs to be adapted to their unique challenges. Second, resources must be more easily accessible throughout childhood and adolescence. Third, planning for transition to adult care is essential to ensure continuity of services. Finally, they identified that the school system is an essential component of the continuum of care. CONCLUSIONS Adolescents and young adults with CHD are at high risk of developing physical, academic and psychosocial challenges; however, timely identification of challenges does not appear to be optimal across domains and transition points, from the perspective of the youth themselves. Youth with CHD reported not having the resources and supports they required to optimize their functioning. Our findings suggest that several approaches could be adopted to enhance identification and outcomes to address the limitations of current Canadian practices.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.,Ingram School of Nursing, McGill University, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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12
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Neurodevelopmental Outcomes in Children with Congenital Heart Disease: Ten Years After the American Heart Association Statement. Clin Perinatol 2023; 50:53-66. [PMID: 36868713 DOI: 10.1016/j.clp.2022.10.002] [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: 03/05/2023]
Abstract
Even before birth, children with congenital heart disease (CHD) are at risk for neurodevelopmental concerns, with additional insults occurring as part of their treatment course and from subsequent exposures to socioeconomic stressors. With multiple affected neurodevelopmental domains, individuals with CHD face lifelong cognitive, academic, psychological, and quality-of-life difficulties. Early and repeated neurodevelopmental evaluation is key to receiving appropriate services. However, obstacles at the level of the environment, provider, patient, and family can make the completion of these evaluations difficult. Future neurodevelopmental endeavors should aim to evaluate CHD-specific programs, their effectiveness, and barriers to access.
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13
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Watkins S, Kemper AR, D'Ottavio A, Hoffman TM, Hartman RJ, Sang CJ, Sarno L, Paolillo J, Welke KF, Walsh MJ, Forestieri N, Li JS. Third-Grade Academic Performance and Episodes of Cardiac Care Among Children with Congenital Heart Defects. Pediatr Cardiol 2023; 44:472-478. [PMID: 36454266 DOI: 10.1007/s00246-022-03066-w] [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: 09/13/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
Children with congenital heart defects (CHDs) are at risk for poor academic performance. The degree to which receipt of health care services is associated with adverse academic outcomes is not known. We examined the association between episodes of cardiac care and third-grade performance in children with CHD. We identified subjects between 1/1/2008 and 4/30/2012 among 5 centers in North Carolina. We classified children by CHD type and linked subjects to the state educational records. Any inpatient or outpatient cardiac encounter on a date of service was considered an encounter. We calculated the number of encounters by adding the number of inpatient or outpatient cardiac visits prior to the date of the end-of-grade (EOG) tests. We estimated the odds of failing third-grade reading or math EOG tests by episodes of care stratified at the 50th percentile, controlling for CHD type, maternal education, sex, race/ethnicity, birth weight, and gestational age. A total of 184 children had third-grade EOG scores linked to health care records. The median number of episodes of care was 4 (range: 1-60). Those with visits ˃ 50th percentile (> 4 encounters/year over the 4.3 year observation period) had 2.09 (95% CI 1.04, 4.21) greater odds of failing the math EOG compared to those ≤ 50th percentile (1-4 encounters). The third-grade math score declined by 1.5 points (P < 0.008) for every 10 episodes of care. There was no association of episodes of care on third-grade reading performance. Children with CHD with > 4 episodes of cardiac care/year may be at risk for delays in third-grade academic performance. Strategies to minimize school absenteeism may improve academic success in this population.
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Affiliation(s)
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Robert J Hartman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Joseph Paolillo
- Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Karl F Welke
- Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Michael J Walsh
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nina Forestieri
- Department of Health and Human Services, North Carolina, Raleigh, NC, USA
| | - Jennifer S Li
- Duke University, Durham, NC, USA. .,Duke University Medical Center, Box 3090, Durham, NC, 27710, USA.
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14
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Memory Problems in Children With Congenital Heart Disease: A Narrative Review. J Neurosurg Anesthesiol 2023; 35:136-141. [PMID: 36745178 DOI: 10.1097/ana.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Care for congenital heart diseases (CHD) has improved significantly over the past several decades, and children with CHD are now surviving into adulthood. Cognitive and behavioral problems affect children with CHD more than healthy peers. A review of performance on neuropsychological memory tasks has not been reported. We aimed to summarize the published literature on memory problems in people with CHD. METHODS We searched Pubmed, Medline, and PsycINFO from January 1, 1986 to March 22, 2022 to reflect modern care for people with CHD. Our inclusion criteria were randomized controlled trials or observational studies that included children with CHD older than age 3 years, which reported the results of at least 1 neuropsychological test of memory in the CHD group. Our exclusion criteria were studies that included heart transplant recipients and studies that included children who required extracorporeal membrane oxygenation. RESULTS Thirty-one studies that met our inclusion criteria and avoided exclusion criteria were included in this review. Several studies reported deficits in the subdomains of short-term and long-term memory and visual and verbal memory, though we found substantial heterogeneity across studies. The most likely subdomain to be affected in children with CHD appears to be short-term visual memory. CONCLUSIONS There is likely an increased risk of memory problems for children and adults with CHD. We were unable to quantify the risk of memory problems due to the heterogeneity of published studies. Future research should make efforts to account for confounding variables and standardize outcome measures.
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15
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Moon JK, Lawrence KM, Hunt ML, Davey MG, Flake AW, Licht DJ, Chen JM, Kilbaugh TJ, Gaynor JW, Beiting DP. Chronic hypoxemia induces mitochondrial respiratory complex gene expression in the fetal sheep brain. JTCVS OPEN 2022; 10:342-349. [PMID: 36004209 PMCID: PMC9390414 DOI: 10.1016/j.xjon.2022.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
Objective The molecular pathways underlying hypoxemia-induced alterations in neurodevelopment of infants with congenital heart disease have not been delineated. We used transcriptome analysis to investigate differential gene expression induced by hypoxemia in an ovine artificial-womb model. Methods Mid-gestation fetal sheep (median [interquartile range] 109 [107-112] days' gestation) were cannulated via the umbilical vessels, attached to a pumpless, low-resistance oxygenator circuit, and incubated in a sterile, fluid environment for 22 [21-23] days. Fetuses were maintained with an oxygen delivery of 20-25 mL/kg/min (normoxemia, n = 3) or 14-16 mL/kg/min (hypoxemia, n = 4). Transcriptional profiling by RNA sequencing was carried out on left frontal brains and hypoxemia-regulated genes were identified by differential gene expression analysis. Results A total of 228 genes whose expression was up or down regulated by ≥1.5-fold (false discovery rate ≤0.05) were identified. The majority of these genes were induced in hypoxemic animals compared to normoxemic controls, and functional enrichment analysis identified respiratory electron transport as a pathway strongly upregulated in the brain during chronic hypoxemia. Further examination of hypoxemia-induced genes showed robust induction of all 7 subunits of the mitochondrial NADH:ubiquinone oxidoreductase (complex I). Other hypoxemia-induced genes included cytochrome B, a component of complex III, and ATP6, ATP8, both of which are components of complex V. Conclusions Chronic fetal hypoxemia leads to upregulation of multiple mitochondrial respiratory complex genes critical for energy production and reactive oxygen species generation, including complex I. These data provide valuable insight into potential pathways involved in chronic hypoxemia-induced neuropathology and offers potential therapeutic targets for fetal neuroprotection in fetuses with congenital heart defects.
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Affiliation(s)
- James K. Moon
- Department of Surgery, The Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pa
- Department of General Surgery, Mount Sinai Hospital, New York, NY
| | - Kendall M. Lawrence
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Mallory L. Hunt
- Department of Surgery, The Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pa
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Marcus G. Davey
- Department of Surgery, The Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Alan W. Flake
- Department of Surgery, The Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Daniel J. Licht
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jonathan M. Chen
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Todd J. Kilbaugh
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J. William Gaynor
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
- Address for reprints: J. William Gaynor, MD, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevards, Philadelphia, PA 19104.
| | - Daniel P. Beiting
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pa
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16
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Chronic foetal hypoxaemia does not cause elevation of serum markers of brain injury. Cardiol Young 2022; 32:732-737. [PMID: 34365994 DOI: 10.1017/s1047951121002894] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The objective of this study was to investigate changes in serum biomarkers of acute brain injury, including white matter and astrocyte injury during chronic foetal hypoxaemia. We have previously shown histopathological changes in myelination and neuronal density in fetuses with chronic foetal hypoxaemia at a level consistent with CHD. METHODS Mid-gestation foetal sheep (110 ± 3 days gestation) were cannulated and attached to a pumpless, low-resistance oxygenator circuit, and incubated in a sterile fluid environment mimicking the intrauterine environment. Fetuses were maintained with an oxygen delivery of 20-25 ml/kg/min (normoxemia) or 14-16 ml/kg/min (hypoxaemia). Myelin Basic Protein and Glial Fibrillary Acidic Protein serum levels in the two groups were assessed by ELISA at baseline and at 7, 14, and 21 days of support. RESULTS Based on overlapping 95% confidence intervals, there were no statistically significant differences in either Myelin Basic Protein or Glial Fibrillary Acidic Protein serum levels between the normoxemic and hypoxemic groups, at any time point. No statistically significant correlations were observed between oxygen delivery and levels of Myelin Basic Protein and Glial Fibrillary Acidic Protein. CONCLUSION Chronic foetal hypoxaemia during mid-gestation is not associated with elevated serum levels of acute white matter (Myelin Basic Protein) or astrocyte injury (Glial Fibrillary Acidic Protein), in this model. In conjunction with our previously reported findings, our data support the hypothesis that the brain dysmaturity with impaired myelination found in fetuses with chronic hypoxaemia is caused by disruption of normal developmental pathways rather than by direct cellular injury.
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17
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Adaptive Functioning in Adolescents with Congenital Heart Disease Referred for Neurodevelopmental Follow-Up. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022. [DOI: 10.1007/s40817-022-00120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Sekine S, Kobayashi K, Ochiai R, Higaki T. Content validity of the Japanese version of the health literacy and resiliency scale for youth with chronic illness. Front Pediatr 2022; 10:978079. [PMID: 36479281 PMCID: PMC9720298 DOI: 10.3389/fped.2022.978079] [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: 06/25/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
Health literacy, which is the ability to find, understand, and use information as well as services to make informed health-related decisions and actions, is essential for ensuring that youths with chronic diseases adapt to and live with their illnesses. However, in Japan, an appropriate approach for measuring health literacy levels among children is yet to be developed. The Health Literacy and Resiliency Scale for Youth (HLRS-Y) was developed by Kathy Bradley-Klug and her colleagues to assess health literacy, resiliency, and self-advocacy/support among youths aged between 13 and 21 years with chronic illnesses in the United States of America (United States). In this study, we aimed to develop a Japanese version of the HLRS-Y and evaluate its content validity. After receiving approvals from the original authors, four nurse researchers with expertise in pediatric nursing translated the scale into Japanese (forward translation). Afterwards, the appropriateness of each expression was examined by a pediatrician. Next, an English native speaker translated the expressions into English (back-translation). We reported the back-translated version of the scale to the original authors to confirm its accuracy. The scale's content validity index (CVI) was evaluated by health professionals working in the fields of pediatric, transitional, and adult health care. The participants rated the items using a four-point scale. Each item was evaluated for a minimum item-level content validity index (I-CVI) value of 0.78. The scale's total and subscale validities were evaluated using a minimum scale-level content validity index based on an average (S-CVI/Ave) value of 0.90. Eleven participants responded to an online survey for evaluating content validity. Of the 36 items, 34 met the I-CVI criteria. Two items did not exceed the criteria's value, but they approximated it. The values of the S-CVI/Ave were 0.96, thereby satisfying the criteria's requirements. Based on the results, it was confirmed that the Japanese version of the HLRS-Y had good content validity. Future studies should examine the factor validity, known group validity, and reliability of this scale.
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Affiliation(s)
- Saya Sekine
- Department of Child Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, Tokyo, Japan
| | - Kyoko Kobayashi
- Department of Child Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, Tokyo, Japan
| | - Ryota Ochiai
- Department of Nursing, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology Center for Transition to Adult Congenital Health Disease, Graduate School of Medicine, Ehime University, Ehime, Japan
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19
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Alam S, Ilardi D, Cadiz E, Kelleman M, Oster ME. Impact of Cardiac Neurodevelopmental Evaluation for Children with Congenital Heart Disease. Dev Neuropsychol 2021; 47:32-41. [PMID: 34894903 DOI: 10.1080/87565641.2021.2009482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with congenital heart disease (CHD) are at increased risk for neurodevelopmental delays. This study of school-aged children with single ventricle CHD compared access to services for those who did and did not complete an evaluation. Children completing an evaluation had more academic services, including an Individualized Education Plan (66% vs 34%,P = .017), small group academic instruction (54% vs 20%,P = .01), any instructional supports (77% vs 44%,P = .008). A barrier to not completing the evaluation was lack of knowledge about the Cardiac Neurodevelopmental Program (82%). The neurodevelopmental evaluation is an impactful tool that can increase access to school services in vulnerable CHD patients.
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Affiliation(s)
- Sabikha Alam
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
| | - Dawn Ilardi
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States.,Department of Neuropsychology, Children's Healthcare of Atlanta, and Department of Rehabilitation Medicine, Emory University, Atlanta, United States
| | - Emilia Cadiz
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
| | - Michael Kelleman
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
| | - Matthew E Oster
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
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20
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Neurodevelopmental Outcome of Children with Congenital Heart Disease: A Cohort Study from Infancy to Preschool Age. J Pediatr 2021; 239:126-135.e5. [PMID: 34454950 DOI: 10.1016/j.jpeds.2021.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize the neuropsychological outcome of children with congenital heart disease (CHD) at age 5 years; the stability of cognitive and language abilities across childhood; and to identify early neurodevelopmental markers of neuropsychological outcomes in these children. STUDY DESIGN Five-year-old children (n = 55) with complex CHD were assessed using standardized and comprehensive neuropsychological measures. Stability of language and cognitive performance was assessed by comparing standardized scores between ages 1, 2, and 5 years old. Association between 5-year-old skills and scores obtained in early childhood was studied to identify potential early markers of preschool performance. Receiver operating characteristic curves were used to evaluate the classification accuracy of Bayley Scales of Infant Development, Third Edition scales in identifying later impairments. RESULTS At age 5 years, our cohort obtained scores significantly below the norms on most developmental domains, with 35% to 65% of participants showing impaired short-term/working memory, attention, and preacademic skills. Developmental patterns measured between ages 1 and 5 years were different for cognitive and language domains, with a decline with age for cognitive functioning and stable results for expressive language. The Bayley Scales of Infant Development, Third Edition language scores at age 2 years provided a good predictive value in identifying children with impaired language at age 5 years. CONCLUSIONS In our cohort, we found a high prevalence of impairments affecting higher-order cognitive domains. Although language difficulties can be detected as early as 2 years of age, other neuropsychological impairments, such as attention and pre-academic skills, only appear later during development, which reinforces the need for long-term monitoring and systematic assessment before school entry.
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21
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Glinianaia SV, McLean A, Moffat M, Shenfine R, Armaroli A, Rankin J. Academic achievement and needs of school-aged children born with selected congenital anomalies: A systematic review and meta-analysis. Birth Defects Res 2021; 113:1431-1462. [PMID: 34672115 PMCID: PMC9298217 DOI: 10.1002/bdr2.1961] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/09/2022]
Abstract
Children with congenital anomalies have poorer intellectual and cognitive development compared to their peers, but evidence for academic achievement using objective measures is lacking. We aimed to summarize and synthesize evidence on academic outcomes and special education needs (SEN) of school‐aged children born with selected major structural congenital anomalies. Electronic databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, ProQuest Natural Science and Education Collections), reference lists and citations for 1990–2020 were systematically searched. We included original‐research articles on academic achievement in children with non‐syndromic congenital anomalies that involved school test results, standardized tests and/or SEN data. Random‐effects meta‐analyses were performed to estimate pooled mean test scores in mathematics and/or reading where possible and pooled odds ratios (ORs) for SEN in children with severe congenital heart defects (CHDs) and children with orofacial clefts (OFCs). Thirty‐nine eligible studies (n = 21,066 children) were synthesized narratively. Sixteen studies were included in meta‐analyses. Children with non‐syndromic congenital anomalies were at a higher risk of academic underachievement than controls across school levels. Children with severe CHD (pooled OR = 2.32, 95% CI: 1.90, 2.82), and children with OFC (OR = 1.38 (95% CI: 1.20, 1.57), OR = 3.07 (95% CI: 2.65, 3.56), and OR = 3.96 (95% CI: 3.31, 4.72) for children with cleft lip, cleft palate and cleft lip/palate, respectively) had significantly higher ORs for SEN than controls. Children with non‐syndromic congenital anomalies underperform academically and have higher SEN rates compared to their peers. Early monitoring and development of differential SEN are important to promote academic progress in these children.
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Affiliation(s)
- Svetlana V Glinianaia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ashleigh McLean
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebekka Shenfine
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annarita Armaroli
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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22
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Sanz JH, Anixt J, Bear L, Basken A, Beca J, Marino BS, Mussatto KA, Nembhard WN, Sadhwani A, Sananes R, Shekerdemian LS, Sood E, Uzark K, Willen E, Ilardi D. Characterisation of neurodevelopmental and psychological outcomes in CHD: a research agenda and recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2021; 31:876-887. [PMID: 34082845 PMCID: PMC8429101 DOI: 10.1017/s1047951121002146] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Neurodevelopmental and Psychological Outcomes Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute with the goals of identifying knowledge gaps regarding the neurodevelopmental and psychological outcomes of individuals with CHD and investigations needed to advance science, policy, clinical care, and patient/family outcomes. Accurate characterisation of neurodevelopmental and psychological outcomes in children with CHD will drive improvements in patient and family outcomes through targeted intervention. Decades of research have produced a generalised perspective about neurodevelopmental and psychological outcomes in this heterogeneous population. Future investigations need to shift towards improving methods, measurement, and analyses of outcomes to better inform early identification, prevention, and intervention. Improved definition of underlying developmental, neuropsychological, and social-emotional constructs is needed, with an emphasis on symptom networks and dimensions. Identification of clinically meaningful outcomes that are most important to key stakeholders, including patients, families, schools and providers, is essential, specifically how and which neurodevelopmental differences across the developmental trajectory impact stakeholders. A better understanding of the discontinuity and patterns of neurodevelopment across the lifespan is critical as well, with some areas being more impactful at some ages than others. Finally, the field needs to account for the impact of race/ethnicity, socio-economic status, cultural and linguistic diversity on our measurement, interpretation of data, and approach to intervention and how to improve generalisability to the larger worldwide population of patients and families living with CHD.
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Affiliation(s)
- Jacqueline H. Sanz
- Division of Neuropsychology, Children’s National Hospital, Departments of Psychiatry and Behavioral Sciences & Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Julia Anixt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laurel Bear
- Department of Pediatrics, Medical College of Wisconsin, Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | | | - John Beca
- Department of Intensive Care, Starship Children’s Health, Auckland, New Zealand
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | | | - Wendy N. Nembhard
- Department of Epidemiology and the Arkansas Birth Defects Center for Research and Prevention, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anjali Sadhwani
- Department of Psychiatry, Boston Children’s Hospital & Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Renee Sananes
- Division of Cardiology, Department of Psychology, The Hospital for Sick Children, Department of Pediatrics, The University of Toronto, Toronto, Canada
| | - Lara S. Shekerdemian
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Houston, TX, USA
| | - Erica Sood
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE & Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Karen Uzark
- Department of Pediatrics, Section of Pediatric Cardiology, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Elizabeth Willen
- Division of Developmental and Behavioral Sciences and the Ward Family Heart Center, Children’s Mercy, Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
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23
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Sterling LH, Liu A, Ganni E, Therrien J, Dancea AB, Guo L, Marelli AJ. Neurocognitive disorders amongst patients with congenital heart disease undergoing procedures in childhood. Int J Cardiol 2021; 336:47-53. [PMID: 33965470 DOI: 10.1016/j.ijcard.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/28/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amongst children with congenital heart disease (CHD), earlier age of repair improves cardiovascular outcomes. The effects of early intervention on neurodevelopment remains unclear. We assessed the association between early life repair, cardiopulmonary bypass (CPB) and the incidence of neurocognitive disorders (NCD) amongst CHD patients. METHODS We created two retrospective cohorts from the Quebec CHD Database; with data from 1988 to 2010. Complexity of reparative procedures for CHD lesions were used as the proxy of CPB exposure with more complex procedure means longer exposure to CPB. Study Population 1 included pediatric patients with a single reparative procedure and compared patients with complex (long CBP) versus isolated shunt (short CBP) lesions. To assess the effects of CPB alone in Study Population 2 we compared patients with isolated atrial septal defects (ASD) who had surgical (short CBP) versus percutaneous (no CBP) repairs. The primary endpoint for both cohorts was development of an NCD. RESULTS In Study population 1, 1174 patients underwent complex surgical repair and 1620 had a shunt closure. The incidence of NCDs was 2.45/100 person-years in the complex surgery group, and 2.08/100 person-years in the shunt closure group. The following were associated with increased risk of developing a NCD: surgical complexity (Hazard Ratio [HR] = 1.20, 95% Confidence Interval [CI]: 1.01-1.42), younger age at intervention (AAI) (HR = 1.20, 95% CI: 1.16-1.25), male sex (HR = 1.91, 95% CI: 1.61-2.27), and later calendar year at intervention (HR = 1.06, 95% CI: 1.04-1.07). Study population 2 had 527 isolated ASD patients; 202 underwent surgical repair and 325 had percutaneous closure. The incidence of NCDs was not statistically different between groups. Male sex (HR = 1.77, 95% CI: 1.08-2.89) and younger AAI (HR = 1.15, 95% CI: 1.06-1.25) were associated with increased NCD risk. CONCLUSION Increased surgical complexity, male sex and younger AAI were associated with increased risk of NCDs in pediatric CHD patients. Surveillance protocols should be considered to identify NCDs in CHD patients after cardiac intervention.
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Affiliation(s)
- Lee H Sterling
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada
| | - Elie Ganni
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Judith Therrien
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada
| | - Adrian B Dancea
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Liming Guo
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada
| | - Ariane J Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada.
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24
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Neurodevelopmental evaluation for school-age children with congenital heart disease: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2020; 30:1623-1636. [PMID: 33143766 DOI: 10.1017/s1047951120003546] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In 2012, the American Heart Association and the American Academy of Paediatrics released a scientific statement with guidelines for the evaluation and management of the neurodevelopmental needs of children with CHD. Decades of outcome research now highlight a range of cognitive, learning, motor, and psychosocial vulnerabilities affecting individuals with CHD across the lifespan. The number of institutions with Cardiac Neurodevelopmental Follow-Up Programmes and services for CHD is growing worldwide. This manuscript provides an expanded set of neurodevelopmental evaluation strategies and considerations for professionals working with school-age children with CHD. Recommendations begin with the referral process and access to the evaluation, the importance of considering medical risk factors (e.g., genetic disorders, neuroimaging), and the initial clinical interview with the family. The neurodevelopmental evaluation should take into account both family and patient factors, including the child/family's primary language, country of origin, and other cultural factors, as well as critical stages in development that place the child at higher risk. Domains of assessment are reviewed with emphasis on target areas in need of evaluation based on current outcome research with CHD. Finally, current recommendations are made for assessment batteries using a brief core battery and an extended comprehensive clinical battery. Consistent use of a recommended assessment battery will increase opportunities for research collaborations, and ultimately help improve the quality of care for families and children with CHD.
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25
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A transition clinic intervention to improve follow-up rates in adolescents and young adults with congenital heart disease. Cardiol Young 2020; 30:633-640. [PMID: 32279695 PMCID: PMC7778829 DOI: 10.1017/s1047951120000682] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with congenital heart disease (CHD) require lifelong cardiology follow-up. Many experience gaps in care around the age of transition to adult-oriented care with associated comorbidity. We describe the impact of a clinic-based intervention on follow-up rates in this high-risk population. METHODS Patients ≥11 years seen in a paediatric outpatient CHD Transition Clinic completed self-assessment questionnaires, underwent focused teaching, and were followed on a clinic registry with assessment of care continuation. The cohort "lost to follow-up" rate, defined as absence from care at least 6 months beyond the recommended timeframe, was compared with a control group. Secondary outcomes included questionnaire scores and adult cardiology referral trends. RESULTS Over 26 months, 53 participants completed an initial Transition Clinic visit; 43% (23/53) underwent a second visit. Median participant age was 18.0 years (interquartile range 16.0, 22.0). The cohort's "lost to follow-up" rate was 7.3%, which was significantly lower than the control rate (25.9%, p < 0.01). Multivariable regression analyses demonstrated clinic participation as the only factor independently associated with follow-up rates (p = 0.048). Transition readiness was associated with older age (p = 0.01) but not sex, univentricular heart, interventional history, or surgical complexity. One-third of adult participants transferred to adult care. CONCLUSIONS A CHD Transition Clinic intervention can improve follow-up rates in adolescents and young adults. Age is an important factor in transition readiness, and retention of adults in paediatric care appears multi-factorial. We postulate that serial assessments of self-management, focused education, and registry utilisation may improve patient outcomes by reducing lapses in care.
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26
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Ekure EN, Sokunbi O, Kalu N, Olusegun-Joseph A, Kushimo O, Amadi C, Hassan O, Ikebudu D, Onyia S, Onwudiwe C, Nwankwo V, Akinwunmi R, Awusa F, Akere Z, Dele-Salawu O, Ajayi E, Ale O, Muoneke D, Muenke M, Kruszka P, Beaton A, Sable C, Adeyemo A. Congenital heart disease in school children in Lagos, Nigeria: Prevalence and the diagnostic gap. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:47-52. [PMID: 32052942 DOI: 10.1002/ajmg.c.31779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 02/04/2023]
Abstract
Congenital heart disease (CHD) in low-and-middle income countries (LMIC) is often characterized by late presentation resulting from inadequate screening and healthcare access in these regions. Accurate estimates of the burden of CHD among school children are often lacking. The objective of this study was to determine the prevalence and distribution of CHD among school children in two communities (urban and semi-urban) in south western Nigeria. Using clinical assessment and portable echocardiography, 4107 school children aged 5 years to 16 years in Lagos, Nigeria, were selected using a multistage sampling procedure and screened for CHD. Diagnosis of CHD was made after echocardiography. Children identified with CHD were referred to a tertiary hospital for appropriate cardiac care. The 4,107 children screened had a mean age of 11.3 ± 2.7 years and 53.7% were females. Twenty seven children had echocardiography-confirmed CHD, representing a prevalence of CHD among school children in Lagos, Nigeria of 6.6 per 1000 children. Acyanotic CHD constituted 96.3% of detected cases. Two children diagnosed with CHD (Tetralogy of Fallot and severe pulmonary valve stenosis respectively) had successful intervention. The prevalence of previously undiagnosed CHD among school children in Lagos Nigeria is substantial and highlights gaps in the health care system and school health programs. Echocardiographic screening of school children provides an opportunity for missed early diagnosis and treatment of CHD and reduces the prevalence of first-diagnosed CHD in adulthood. Therefore, focused clinical examination of school children followed by echocardiography is a strategy that could bridge this diagnostic and treatment gap in CHD.
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Affiliation(s)
- Ekanem N Ekure
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ogochukwu Sokunbi
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nnenna Kalu
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Akinsanya Olusegun-Joseph
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole Kushimo
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Casmir Amadi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olayinka Hassan
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Desmond Ikebudu
- Central Research Laboratory, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sophia Onyia
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinonso Onwudiwe
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Victor Nwankwo
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Remi Akinwunmi
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Fukpode Awusa
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Zainab Akere
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olaolu Dele-Salawu
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Elizabeth Ajayi
- Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olagoke Ale
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Dorothy Muoneke
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maximillian Muenke
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul Kruszka
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Craig Sable
- Children's National Medical Center, Washington, District of Columbia
| | - Adebowale Adeyemo
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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27
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Glotzbach KL, Ward JJ, Marietta J, Eckhauser AW, Winter S, Puchalski MD, Miller TA. The Benefits and Bias in Neurodevelopmental Evaluation for Children with Congenital Heart Disease. Pediatr Cardiol 2020; 41:327-333. [PMID: 31865442 DOI: 10.1007/s00246-019-02260-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Neurodevelopmental (ND) impairment is common in children with congenital heart disease (CHD). While routine ND surveillance and evaluation of high-risk patients has become the standard-of-care, capture rate, barriers to referral, and potential patient benefits remain incompletely understood. Electronic data warehouse records from a single center were reviewed to identify all eligible and evaluated patients between July 2015 and December 2017 based on current guidelines for ND screening in CHD. Diagnoses, referring provider, and payor were considered. Potential benefit of the evaluation was defined as receipt of new diagnosis, referral for additional evaluation, or referral for a new service. Contingencies were assessed with Fisher's exact test. In this retrospective, cohort study, of 3434 children identified as eligible for ND evaluation, 135 were evaluated (4%). Appropriate evaluation was affected by diagnostic bias against coarctation of the aorta (CoArc) and favoring hypoplastic left heart syndrome (HLHS) (1.8 vs. 11.9%, p<0.01). Referrals were disproportionally made by a select group of cardiologists, and the rate of ND appointment non-compliance was higher in self-pay compared to insured patients (78% vs 27%, p<0.01). Potential benefit rate was 70-80% amongst individuals with the three most common diagnoses requiring neonatal surgery (CoArc, transposition of the great arteries, and HLHS). Appropriate ND evaluation in CHD is impacted by diagnosis, provider, and insurance status. Potential benefit of ND evaluation is high regardless of diagnosis. Strategies to improve access to ND evaluations and provider understanding of the at-risk population will likely improve longitudinal ND surveillance and clinical benefit.
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Affiliation(s)
- Kristi L Glotzbach
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.
| | - John J Ward
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jennifer Marietta
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Aaron W Eckhauser
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Sarah Winter
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael D Puchalski
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Thomas A Miller
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
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28
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Phillips JM, Longoria JN. [Formula: see text] Addressing the neurodevelopmental needs of children and adolescents with congenital heart disease: A review of the existing intervention literature. Child Neuropsychol 2019; 26:433-459. [PMID: 31672097 DOI: 10.1080/09297049.2019.1682131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital heart disease (CHD) is among the most prevalent birth defects in the United States. Given that children with CHD are at risk for differences with development, learning, and psychosocial functioning, effective intervention becomes a central tenant of recommendations following neuropsychological consultation and evaluation. The primary focus of this review is to summarize available interventions for children and adolescents with CHD. The existing CHD literature has concentrated on early developmental services, psychopharmacological treatment, and need for academic supports. The literature is limited with regard to intervention studies that target cognitive deficits and psychosocial difficulties. To address this discrepancy, efficacious interventions that have been used to mitigate these concerns within other medical groups are also discussed in an effort to provide options for alternative recommendations and services. The current paper is intended to facilitate comprehensive care for cardiac patients by providing clinicians with a review of the available intervention literature, as well as potential interventions that may serve as supplemental strategies in the interim.
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Affiliation(s)
- Jannel M Phillips
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI, USA
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29
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Sigmon ER, Kelleman M, Susi A, Nylund CM, Oster ME. Congenital Heart Disease and Autism: A Case-Control Study. Pediatrics 2019; 144:peds.2018-4114. [PMID: 31601611 DOI: 10.1542/peds.2018-4114] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There has long been an association between congenital heart disease (CHD) and general neurodevelopmental delays. However, the association between CHD and autism spectrum disorders (AuSDs) is less well understood. Using administrative data, we sought to determine the association between CHD and AuSD and identify specific CHD lesions with higher odds of developing AuSD. METHODS We performed a 1:3 case-control study of children enrolled in the US Military Health System from 2001 to 2013. Children with International Classification of Disease, Ninth Revision, Clinical Modification codes for AuSD were identified as cases and matched with controls on the basis of date of birth, sex, and enrollment time frame. Each child's records were reviewed for CHD lesions and associated procedures. Conditional logistic regression determined odds ratios (ORs) and 95% confidence intervals (CIs) for comparative associations. RESULTS There were 8760 cases with AuSD and 26 280 controls included in the study. After adjustment for genetic syndrome, maternal age, gestational diabetes, short gestation, newborn epilepsy, birth asphyxia, and low birth weight, there were increased odds of AuSD in patients with CHD (OR 1.32; 95% CI 1.10-1.59). Specific lesions with significant OR included atrial septal defects (n = 82; OR 1.72; 95% CI 1.07-2.74) and ventricular septal defects (n = 193; OR 1.65; 95% CI 1.21-2.25). CONCLUSIONS Children with CHD have increased odds of developing AuSD. Specific lesions associated with increased risk include atrial septal defects and ventricular septal defects. These findings will be useful for counseling parents of children with CHD.
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Affiliation(s)
- Eric R Sigmon
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta and.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
| | - Michael Kelleman
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
| | - Apryl Susi
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Cade M Nylund
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew E Oster
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta and .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
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30
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Lawley CM, Winlaw DS, Sholler GF, Martin A, Badawi N, Walker K, Nassar N, Lain SJ. School-Age Developmental and Educational Outcomes Following Cardiac Procedures in the First Year of Life: A Population-Based Record Linkage Study. Pediatr Cardiol 2019; 40:570-579. [PMID: 30535960 DOI: 10.1007/s00246-018-2029-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to evaluate school-age developmental and educational outcomes for children with and without a cardiac procedure in the first year of life to improve understanding of longer-term neurodevelopmental outcomes in children who have had a cardiac procedure for congenital heart disease, the most common serious congenital anomaly. A population-based cohort study using record linkage of state-wide data was undertaken, evaluating children born in New South Wales, Australia, 2001-2007. Those with and without a cardiac procedure in the first year of life with a linked developmental (Australian version Early Development Instrument testing result, age 4-6 years) and/or educational outcome (Australian National Assessment Program result, age 7-9 years) were included. Perinatal, perioperative and sociodemographic factors were examined using multivariable logistic regression models. Of 468,329 eligible children, 768 had a cardiac procedure in the first year of life and 582 were included. For those with a cardiac procedure and developmental outcome (n = 260), 13.1% were classified as having 'special needs' compared to 4.4% without a cardiac procedure. Of those with an educational outcome, after adjusting for perinatal, perioperative and demographic variables, children with a cardiac procedure (n = 396) were twice as likely to score below National Minimum Standard in school literacy and numeracy tests compared to their peers. Significant predictors included low birthweight, parent not completing school and having > 4 re-hospitalisations in their first six years. The developmental and educational trajectory of children who have had a cardiac procedure in their first year remains altered into primary school years. While perioperative factors did not impact outcomes, ongoing health and sociodemographic factors were important in identifying those children at greatest risk.
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Affiliation(s)
- Claire M Lawley
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia. .,Heart Centre for Children, Sydney Children's Hospital Network, The Children's Hospital, Westmead, NSW, Australia. .,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - David S Winlaw
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Heart Centre for Children, Sydney Children's Hospital Network, The Children's Hospital, Westmead, NSW, Australia
| | - Gary F Sholler
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Heart Centre for Children, Sydney Children's Hospital Network, The Children's Hospital, Westmead, NSW, Australia
| | - Andrew Martin
- School of Education (Educational Psychology Research Group), University of New South Wales, Sydney, Australia
| | - Nadia Badawi
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Camperdown, NSW, Australia
| | - Karen Walker
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, Camperdown, NSW, Australia
| | - Natasha Nassar
- Discipline of Child & Adolescent Health, Westmead Clinical School, Sydney Medical School, The Children's Hospital, Sydney, NSW, Australia.,Child Population Health Research, Westmead Clinical School, The Children's Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Samantha J Lain
- Child Population Health Research, Westmead Clinical School, The Children's Hospital, The University of Sydney, Sydney, NSW, Australia
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31
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Liamlahi R, Latal B. Neurodevelopmental outcome of children with congenital heart disease. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:329-345. [PMID: 31324319 DOI: 10.1016/b978-0-444-64029-1.00016-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Congenital heart disease (CHD) constitutes the most common congenital malformation, with moderate or severe CHD occurring in around 6 in 1000 live births. Due to advances in medical care, survival rates have increased significantly. Thus, the majority of children with CHD survive until adolescence and adulthood. Children with CHD requiring cardiopulmonary bypass surgery are at risk for neurodevelopmental impairments in various domains, including mild impairments in cognitive and neuromotor functions, difficulties with social interaction, inattention, emotional symptoms, and impaired executive function. The prevalence for these impairments ranges from 20% to 60% depending on age and domain ("high prevalence-low severity"). Domains are often affected simultaneously, leading to school problems with the need for learning support and special interventions. The etiology of neurodevelopmental impairments is complex, consisting of a combination of delayed intrauterine brain development and newly occurring perioperative brain injuries. Mechanisms include altered intrauterine hemodynamic flow as well as neonatal hypoxia and reduced cerebral blood flow. The surgical procedure and postoperative phase add to this cascade of factors interfering with normal brain development. Early identification of children at high risk through structured follow-up programs is mandated to provide individually tailored early interventions and counseling to improve developmental health.
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Affiliation(s)
- Rabia Liamlahi
- Child Development Center, University Children's Hospital Zürich, Zürich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zürich, Zürich, Switzerland.
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32
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Pace ND, Oster ME, Forestieri NE, Enright D, Knight J, Meyer RE. Sociodemographic Factors and Survival of Infants With Congenital Heart Defects. Pediatrics 2018; 142:peds.2018-0302. [PMID: 30111552 DOI: 10.1542/peds.2018-0302] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the first-year survival of infants with congenital heart defects (CHDs) and investigate the potential role of socioeconomic and demographic factors on survival. METHODS Subjects included 15 533 infants with CHDs born between 2004 and 2013 ascertained by the NC Birth Defects Monitoring Program. We classified CHDs into the following 3 groups: critical univentricular (n = 575), critical biventricular (n = 1494), and noncritical biventricular (n = 13 345). We determined vital status and age at death through linkage to state vital records and used geocoded maternal residence at birth to obtain census information for study subjects. We calculated Kaplan-Meier survival estimates by maternal and infant characteristics and derived hazard ratios from Cox proportional hazard models for selected exposures. RESULTS Among all infants with CHDs, there were 1289 deaths (8.3%) in the first year. Among infants with univentricular defects, 61.6% (95% confidence interval [CI]: 57.7%-65.7%) survived. Survival among infants with univentricular defects was considerably better for those whose fathers were ≥35 years old (71.6%; 95% CI: 63.8%-80.3%) compared with those whose fathers were younger (59.7%; 95% CI: 54.6%-65.2%). Factors associated with survival among infants with any biventricular defect included maternal education, race and/or ethnicity, marital status, and delivery at a heart center. The hazard of infant mortality was greatest among non-Hispanic African American mothers. CONCLUSIONS Survival among infants with critical univentricular CHDs was less variable across sociodemographic categories compared with survival among infants with biventricular CHDs. Sociodemographic differences in survival among infants with less severe CHDs reinforces the importance of ensuring culturally effective pediatric care for at-risk infants and their families.
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Affiliation(s)
- Nelson D Pace
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; .,Birth Defects Monitoring Branch, and
| | - Matthew E Oster
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; and.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Dianne Enright
- Health and Spatial Analysis Branch, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Jessica Knight
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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33
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Farr SL, Downing KF, Riehle-Colarusso T, Abarbanell G. Functional limitations and educational needs among children and adolescents with heart disease. CONGENIT HEART DIS 2018; 13:633-639. [PMID: 30033554 DOI: 10.1111/chd.12621] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/28/2018] [Accepted: 04/19/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine how cognitive and motor limitations in children with heart disease are associated with education and participation in extracurricular activities. DESIGN Using 2009-2010 parent-reported data from the National Survey of Children with Special Health Care Needs (NS-CSHCN), we examined prevalence of five functional limitations (learning/concentration, communication, self-care, gross motor skills, and fine motor skills) by diagnosed heart disease status using chi-square tests and multivariable logistic regression. Among CSHCN with heart disease, we examined the associations between severity of each functional limitation and missing ≥11 days of school in the past year, receiving special education services, and interference with extracurricular activities. RESULTS CSHCN with heart disease (n = 1,416), compared to CSHCN without (n = 28,385), more commonly had "a lot" of difficulty in the five functional areas (P < .01; adjusted odds ratios: 1.8-3.3). Among CSHCN with heart disease, "a lot" of difficulty with learning/concentration was most common (35%), followed by communication (21%), self-care (14%), gross motor skills (12%), and fine motor skills (10%). Among CSHCN with heart disease, compared to those without, respectively, 27% and 15% missed ≥11 days of school, 45% and 29% received special education services, and 49% and 29% experienced interference with extracurricular activities (P < .01 for all). Level of difficulty with the five functional areas was associated with receipt of special education services and participation in extracurricular activities (P < .001). CONCLUSION These results support the American Heart Association recommendations to screen children with congenital heart disease for age-appropriate development and provide services when needed.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Tiffany Riehle-Colarusso
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ginnie Abarbanell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri, USA
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34
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Cassidy AR, Ilardi D, Bowen SR, Hampton LE, Heinrich KP, Loman MM, Sanz JH, Wolfe KR. Congenital heart disease: A primer for the pediatric neuropsychologist. Child Neuropsychol 2017; 24:859-902. [DOI: 10.1080/09297049.2017.1373758] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Adam R. Cassidy
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Susan R. Bowen
- Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lyla E. Hampton
- Department of Child & Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Michelle M. Loman
- Departments of Neurology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacqueline H. Sanz
- Division of Neuropsychology, Children’s National Health System, Departments of Psychiatry and Behavioral Sciences & Pediatrics, George Washington University School of Medicine, , Washington, DC, USA
| | - Kelly R. Wolfe
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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35
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Tumin D, Chou H, Hayes D, Tobias JD, Galantowicz M, McConnell PI. Employment after heart transplantation among adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:794-799. [PMID: 28703426 DOI: 10.1111/chd.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Adults with congenital heart disease may require heart transplantation for end-stage heart failure. Whereas heart transplantation potentially allows adults with congenital heart disease to resume their usual activities, employment outcomes in this population are unknown. Therefore, we investigated the prevalence and predictors of work participation after heart transplantation for congenital heart disease. DESIGN Retrospective review of a prospective registry. SETTING United Network for Organ Sharing registry of transplant recipients in the United States. PATIENTS Adult recipients of first-time heart transplantation with a primary diagnosis of congenital heart disease, performed between 2004 and 2015. INTERVENTIONS None. OUTCOME MEASURES Employment status reported by transplant centers at required follow-up intervals up to 5 y posttransplant. RESULTS Among 470 patients included in the analysis (mean follow-up: 5 ± 3 y), 127 (27%) worked after transplant, 69 (15%) died before beginning or returning to work, and 274 (58%) survived until censoring, but did not participate in paid work. Multivariable competing-risks regression analysis examined characteristics associated with posttransplant employment, accounting for mortality as a competing outcome. In descriptive and multivariable analysis, pretransplant work participation was associated with a greater likelihood of posttransplant employment, while the use of Medicaid insurance at the time of transplant was associated with a significantly lower likelihood of working after transplant (subhazard ratio compared to private insurance: 0.55; 95% confidence interval: 0.32, 0.95; P = .032). CONCLUSIONS Employment was rare after heart transplantation for congenital heart disease, and was significantly less common than in the broader population of adults with congenital heart disease. Differences in return to work were primarily related to pretransplant employment and the use of public insurance, rather than clinical characteristics.
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Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Helen Chou
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mark Galantowicz
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Patrick I McConnell
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review. Int J Neonatal Screen 2017; 3:34. [PMID: 29376140 PMCID: PMC5784211 DOI: 10.3390/ijns3040034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011-2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs.
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