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Bainton J, Trachtenberg F, McCrindle BW, Wang K, Boruta R, Brosig CL, Egerson D, Sood E, Calderon J, Doman T, Golub K, Graham A, Haas K, Hamstra M, Lindauer B, Sylvester D, Woodard F, Young-Borkowski L, Mussatto KA. Prevalence and associated factors of post-traumatic stress disorder in parents whose infants have single ventricle heart disease. Cardiol Young 2023; 33:2171-2180. [PMID: 36601959 DOI: 10.1017/s1047951122004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease. MATERIALS AND METHODS A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale - Revised. RESULTS The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder. DISCUSSION Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.
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Affiliation(s)
- Jessica Bainton
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ke Wang
- HealthCore, Watertown, MA, USA
| | | | - Cheryl L Brosig
- Herma Heart Institute, Children's Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Erica Sood
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Tammy Doman
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Katrina Golub
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Karen Haas
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Michelle Hamstra
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Lisa Young-Borkowski
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Driscoll CFB, Christofferson J, McWhorter LG, Demianczyk AC, Brosig CL, Jackson EA, Gramszlo C, Zyblewski SC, Kazak AE, Sood E. A Psychosocial Care Model for Families Affected by Congenital Heart Disease. Pediatr Crit Care Med 2023; 24:901-909. [PMID: 37318266 PMCID: PMC10721719 DOI: 10.1097/pcc.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To develop a model of family-based psychosocial care for congenital heart disease (CHD). DESIGN Qualitative study using crowdsourced data collected from parents of young children with CHD who received care across 42 hospitals. SETTING Yammer, a social networking platform used to facilitate online crowdsourcing and qualitative data collection. SUBJECTS Geographically diverse sample of 100 parents (72 mothers and 28 fathers) of young children with CHD. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Parents joined a private group on Yammer and responded to 37 open-ended study questions over a 6-month period. Qualitative data were coded and analyzed using an iterative process. Three broad themes corresponding to pillars of family-based psychosocial care were identified: pillar 1) parent partnership in family-integrated medical care, pillar 2) supportive interactions focused on parent and family wellbeing, and pillar 3) integrated psychosocial care and peer support for parents and families. Each pillar was supported by subthemes corresponding to specific intervention strategies. Most parents described the need for intervention strategies across multiple pillars, with almost half reporting needs across all three pillars of psychosocial care. Parents' preferences for psychosocial support changed over time with changes to their child's medical status and across care settings (e.g., hospital, outpatient clinic). CONCLUSIONS Results support a model of family-based psychosocial care that is multidimensional and flexible to meet the needs of families affected by CHD. All members of the healthcare team play an important role in providing psychosocial support. Future research incorporating components of implementation science is needed to promote uptake of these findings, with the goal of optimizing family-based psychosocial support in the hospital setting and beyond.
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Affiliation(s)
- Colleen F. Bechtel Driscoll
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Linda G. McWhorter
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Abigail C. Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences & Cardiac Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin & Department of Pediatrics, Medical College of Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Emily A. Jackson
- Department of Patient and Family Services, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Colette Gramszlo
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC, USA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erica Sood
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
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Franklin MK, Karpyn A, Christofferson J, McWhorter LG, Demianczyk AC, Brosig CL, Jackson EA, Lihn S, Zyblewski SC, Kazak AE, Sood E. Barriers and facilitators to discussing parent mental health within child health care: Perspectives of parents raising a child with congenital heart disease. J Child Health Care 2023; 27:360-373. [PMID: 34879743 PMCID: PMC9174345 DOI: 10.1177/13674935211058010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to identify barriers and facilitators to discussing parent mental health within child health care for parents of children with congenital heart disease (CHD). Seventy-nine parents of young children with CHD who received care across 40 hospitals in the United States responded to questions about barriers and facilitators to discussing their mental health with their child's health care providers. Responses were analyzed using qualitative research methods. Parents described multiple barriers: (1) belief that parent mental health support was outside the care team's scope of practice, (2) perceived expectation to "stay strong," (3) fear of negative judgment or repercussion, (4) individual preferences for communication/support, (5) desire to maintain care resources on their child, (6) perceived need to compartmentalize emotions, and (7) negative reactions to past emotional disclosure. Parents also described several facilitators: (1) confidence in the care team's ability to provide support, (2) intentional efforts by the care team to provide support, (3) naturally extroverted tendencies, and (4) developing personal connections with health care providers. It is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.
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Affiliation(s)
- Melanie K. Franklin
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA
| | - Jennifer Christofferson
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Linda G. McWhorter
- Division of Behavioral Health, Department of Pediatrics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Abigail C. Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences & Cardiac Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin & Department of Pediatrics, Medical College of Wisconsin, 8915 W Connell Ct, Milwaukee, WI, 53226, USA
| | - Emily A. Jackson
- Department of Patient and Family Services, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas St. Ste. 601, MSC 617, Charleston, SC, USA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erica Sood
- Center for Healthcare Delivery Science, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Nemours Cardiac Center, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
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Konkel T, Kroll KH, Goertz MT, Lavoie J, Bagli SP, Kogutkiewicz K, Kostroski R, Scott L, Stoll P, Andres J, Saudek D, Handler SS, Brosig CL. Screening for traumatic stress in children and adolescents with congenital heart disease. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ruehl CA, Landry KK, Stoiber KC, Brosig CL. Building a Cardiac Educational Achievement Partnership Program: Examination of Implementation. Circ Cardiovasc Qual Outcomes 2022; 15:e008531. [PMID: 35378987 PMCID: PMC9015034 DOI: 10.1161/circoutcomes.121.008531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Christie A Ruehl
- Community Health and Education, Children's Wisconsin, Milwaukee (C.A.R., K.K.L.)
| | - Kyle K Landry
- Community Health and Education, Children's Wisconsin, Milwaukee (C.A.R., K.K.L.)
| | - Karen C Stoiber
- Department of Educational Psychology, School Psychology Program, University of Wisconsin-Milwaukee (K.C.S.)
| | - Cheryl L Brosig
- Medical College of Wisconsin, Department of Pediatrics, Division of Pediatric Psychology and Developmental Medicine, Children's Wisconsin, Herma Heart Institute, Milwaukee (C.L.B.)
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Brosig CL, Stoiber KC, Landry KK, Ruehl CA, Bella ZA. School considerations for children with heart disease during the COVID-19 pandemic. Sch Psychol 2022; 37:54-61. [PMID: 35191724 DOI: 10.1037/spq0000476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents data on Coronavirus disease (COVID-19)-related learning, health, and mental health concerns of 134 families of children with heart disease (HD), the most common birth defect, who are followed by a unique hospital-based Educational Achievement Partnership Program (EAPP) designed to serve as a liaison across the family, the child's medical team, and school. At-school, remote, and hybrid learning alternatives prompted by the COVID-19 pandemic presented families with an especially complex decision to make for children with HD due to competing complications in this population: Increased susceptibility to illness, greater risk of neuropsychological problems, and higher level of individualized education services that are not readily transferable to a home learning platform. Parents of school-aged children with HD completed a survey about COVID-19-related school support needs as part of a quality improvement project. Survey results revealed 51% of children would learn from home during the 2020-2021 school year due to concerns about the child's underlying health condition, indicating a marked change in schooling modality compared to prior years (4% in 2019). Nearly 75% of families requested medical guidance for COVID-19-related school health and education plan addendums. Seventy-three percent of families had mental health concerns about their child; severity of HD was related to families' reports about mental health concerns. Findings suggest follow-up is needed by school psychologists and medical consultative collaborative partners to support the transition back to in-person schooling after the COVID-19 pandemic concludes and to identify long-term educational consequences of disrupted learning during this period. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Karen C Stoiber
- Department of Educational Psychology, University of Wisconsin-Milwaukee
| | | | | | - Zachary A Bella
- Department of Educational Psychology, University of Wisconsin-Milwaukee
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7
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Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning 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 to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Sananes R, Goldberg CS, Newburger JW, Hu C, Trachtenberg F, Gaynor JW, Mahle WT, Miller T, Uzark K, Mussatto KA, Pizarro C, Jacobs JP, Cnota J, Atz AM, Lai WW, Burns KM, Milazzo A, Votava-Smith J, Brosig CL. Six-Year Neurodevelopmental Outcomes for Children With Single-Ventricle Physiology. Pediatrics 2021; 147:peds.2020-014589. [PMID: 33441486 PMCID: PMC7849196 DOI: 10.1542/peds.2020-014589] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if neurodevelopmental deficits in children with single-ventricle physiology change with age and early developmental scores predict 6-year outcomes. METHODS In the Single Ventricle Reconstruction Trial, Bayley Scales of Infant Development, Second Edition, were administered at 14 months of age, and parents completed the Behavior Assessment System for Children, Second Edition (BASC-2) annually from the ages of 2 to 6 years. Scores were classified as average, at risk, or impaired. We calculated sensitivities, specificities, and positive and negative predictive values of earlier tests on 6-year outcomes. RESULTS Of 291 eligible participants, 244 (84%) completed the BASC-2 at 6 years; more Single Ventricle Reconstruction participants than expected on the basis of normative data scored at risk or impaired on the BASC-2 Adaptive Skills Index at that evaluation (28.7% vs 15.9%; P < .001). Children with Adaptive Skills Composite scores <2 SD below the mean at the age of 6 were more likely to have had delayed development at 14 months, particularly on the Psychomotor Development Index (sensitivity of 79%). However, the positive predictive value of the 14-month Mental Development Index and Psychomotor Development Index for 6-year BASC-2 Adaptive Scores was low (44% and 36%, respectively). Adaptive Skills Composite score impairments at the age of 6 were poorly predicted by using earlier BASC-2 assessments, with low sensitivities at the ages of 3 (37%), 4 (48%), and 5 years (55%). CONCLUSIONS Many children with hypoplastic left heart syndrome who have low adaptive skills at the age of 6 years will not be identified by screening at earlier ages. With our findings, we highlight the importance of serial evaluations for children with critical congenital heart disease throughout development.
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Affiliation(s)
- Renee Sananes
- Department of Pediatrics and Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Canada;
| | - Caren S. Goldberg
- Department of Pediatrics, Michigan Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Chenwei Hu
- New England Research Institutes, Watertown, Massachusetts
| | | | - J. William Gaynor
- Division of Pediatric Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William T. Mahle
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Thomas Miller
- Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah;,Division of Pediatric Cardiology, Maine Medical Center, Portland, Maine
| | - Karen Uzark
- Department of Pediatrics, Michigan Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
| | | | - Christian Pizarro
- Department of Surgery, Nemours Cardiac Center, Alfred I du Pont Hospital for Children, Wilmington, Delaware
| | | | - James Cnota
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Wyman W. Lai
- Children’s Heart Institute, Children’s Hospital of Orange County, Orange, California
| | | | - Angelo Milazzo
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina;,Department of Pediatrics, East Carolina University, Greenville, North Carolina;,Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina; and
| | - Jodie Votava-Smith
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Cheryl L. Brosig
- Pediatrics, Herma Heart Institute, Children’s Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
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Bucholz EM, Sleeper LA, Sananes R, Brosig CL, Goldberg CS, Pasquali SK, Newburger JW. Trajectories in Neurodevelopmental, Health-Related Quality of Life, and Functional Status Outcomes by Socioeconomic Status and Maternal Education in Children with Single Ventricle Heart Disease. J Pediatr 2021; 229:289-293.e3. [PMID: 33031800 PMCID: PMC7855010 DOI: 10.1016/j.jpeds.2020.09.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022]
Abstract
Trajectories of neurodevelopment and quality of life were analyzed in children with hypoplastic left heart syndrome according to socioeconomic status (SES) and maternal education. Lower SES and less maternal education were associated with greater early delays in communication and problem-solving and progressive delays in problem-solving and fine motor skills over time.
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Affiliation(s)
- Emily M Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Renee Sananes
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cheryl L Brosig
- Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Wisconsin, Milwaukee, WI
| | - Caren S Goldberg
- Department of Pediatrics, University of Michigan CS Mott Children's Hospital, Ann Arbor, MI
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan CS Mott Children's Hospital, Ann Arbor, MI
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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10
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Kichler JC, Valenzuela J, Barker D, Noser AE, Brosig CL, Hilliard ME, Christidis P, Stamm KE, Wysocki T, Jelalian E. Society of Pediatric Psychology Workforce Survey: Updated Factors Related to Compensation. J Pediatr Psychol 2020; 45:434-444. [PMID: 32068862 DOI: 10.1093/jpepsy/jsaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/11/2019] [Accepted: 01/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The 2017 Society of Pediatric Psychology (SPP) Workforce Survey provides self-reported compensation by pediatric psychologists, identifies predictors of compensation, and establishes a better understanding of compensation within the context of gender and race/ethnicity minority status. METHODS SPP members who attended the SPP Annual Conference (SPPAC; April 2017) were invited to complete the survey at the conference through electronic tablets provided on-site by the Workforce Survey Committee. The survey was subsequently distributed online to SPP members who did not complete the survey at SPPAC. The statistical analyses used for this salary data employed flexible semi-parametric models, cross-validation, and prediction models for both the overall sample and academic rank subgroups. RESULTS Of 27 potential demographic and employment-related predictors from the 2017 SPP Workforce Survey, significant predictors of salary emerged within this sample: academic rank, time since obtaining doctoral degree, managing internal and external funds (of at least $50,000), years in primary employment position, obtaining Fellowship status in the American Psychological Association (APA), and managing other employees (at least 10 people). Given low response rates for males and individuals who identify as belonging to racial and ethnic minority subgroups, only limited, exploratory results are reported for these subgroups. CONCLUSIONS These findings suggest that not only is longevity in one's career important but managing funds/personnel and obtaining professional designations are also predictors of higher salaries for pediatric psychologists, in general. Specific implications of salary according to the psychologist's academic rank, gender, and racial/ethnicity group status are also explored.
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Affiliation(s)
- Jessica C Kichler
- Cincinnati Children's Hospital Medical Center
- University of Cincinnati College of Medicine
| | | | | | | | - Cheryl L Brosig
- Medical College of Wisconsin
- Children's Hospital of Wisconsin
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Handler SS, Hallis BJ, Tillman KA, Krolikowski M, Kuhn EM, Kirkpatrick EC, Brosig CL. Assessment of quality of life in pediatric patients with pulmonary hypertension. Pulm Circ 2018; 9:2045894018822985. [PMID: 30562156 PMCID: PMC6607578 DOI: 10.1177/2045894018822985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aim of this study is to evaluate quality of life in four domains (physical,
emotional, social, and school) in pediatric patients with pulmonary hypertension
(PH) using a validated survey (PedsQL). This is a prospective cohort study of
pediatric patients aged 2–18 years with PH. Parents of all children and patients
aged 8–18 years with appropriate developmental capacity completed the PedsQL
survey in the clinic. Results were compared with published norms for pediatric
patients, those with congenital heart disease (CHD) and cancer. Thirty-three
children were enrolled yielding 32 parent and 18 patient self-reports: seven
patients were aged 2–4 years; three were aged 5–7 years; 11 were aged 8–12
years, and 12 were aged 13–18 years. Twenty-one patients were classified as
World Health Organization (WHO) Group I pulmonary arterial hypertension (PAH),
11 WHO Group III PH due to lung disease, and one WHO Group V with segmental PH.
Thirteen patients were NYHA functional class (FC) 1, 12 were FC 2, eight were FC
3, and none were FC 4. The PH cohort had significantly lower scores than healthy
children in all domains on both parent and self-report. The PH cohort also had
significantly lower scores than patients with CHD (parent report: total,
physical, social, school; patient self-report: total, physical, school) and
cancer (parent report: school; patient self-report: physical, school). Close to
50% of participants reported at risk scores in each domain. The quality of life
in pediatric PH patients assessed by PedsQL revealed functional impairment in
multiple domains. Administration of the PedsQL during
outpatient encounters may provide an easy, reproducible method to assess quality
of life and direct referral for interventional services.
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Affiliation(s)
- Stephanie S Handler
- 1 Department of Pediatrics (Division of Pediatric Cardiology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian J Hallis
- 1 Department of Pediatrics (Division of Pediatric Cardiology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn A Tillman
- 1 Department of Pediatrics (Division of Pediatric Cardiology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary Krolikowski
- 1 Department of Pediatrics (Division of Pediatric Cardiology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Evelyn M Kuhn
- 2 Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Edward C Kirkpatrick
- 1 Department of Pediatrics (Division of Pediatric Cardiology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cheryl L Brosig
- 1 Department of Pediatrics (Division of Pediatric Cardiology), Medical College of Wisconsin, Milwaukee, WI, USA
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Brosig CL, Bear L, Allen S, Simpson P, Zhang L, Frommelt M, Mussatto KA. Neurodevelopmental outcomes at 2 and 4 years in children with congenital heart disease. CONGENIT HEART DIS 2018; 13:700-705. [PMID: 30191663 DOI: 10.1111/chd.12632] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/29/2018] [Accepted: 05/04/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Children with congenital heart disease (CHD) are at risk for neurodevelopmental (ND) delays. The purpose of this study is to compare the ND testing results of children with CHD at 2 and 4 years of age and determine if rates of ND delays change over time. METHODS Children with CHD completed the Bayley Scales of Infant Development-III (BSID-III) at 2 years of age, and standardized neuropsychological measures at 4 years. Scores were compared with test norms and were classified as: average (within one SD of test mean); at risk (1-2 SDs from the test mean); and delayed (>2 SD from test mean). Pearson correlations and McNemar's exact tests were performed to determine the relationship between test scores at the two times of assessment. RESULTS Sixty-four patients completed evaluations at 24 ± 3 months of age and 4 years of age. BSID-III cognitive and fine motor scores were correlated with preschool IQ and fine motor scores, r = .75 to .87, P < .0001. Agreement in score categories was 79% for cognitive and 61% for fine motor. More patients had at risk or delayed scores at age 4 vs age 2 (P ≤ .01). CONCLUSION(S) Despite significant correlations between 2- and 4-year-old test scores, many patients who scored in the average range at age 2 showed deficits at age 4. BSID-III scores at age 2 may underestimate delays. Therefore, longitudinal ND assessment is recommended.
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Affiliation(s)
- Cheryl L Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Laurel Bear
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Sydney Allen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michele Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen A Mussatto
- Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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13
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Brosig CL, Hilliard ME, Williams A, Armstrong FD, Christidis P, Kichler J, Pendley JS, Stamm KE, Wysocki T. Society of Pediatric Psychology Workforce Survey: Factors Related to Compensation of Pediatric Psychologists. J Pediatr Psychol 2017; 42:355-363. [PMID: 28369549 PMCID: PMC5896597 DOI: 10.1093/jpepsy/jsx051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To summarize compensation results from the 2015 Society of Pediatric Psychology (SPP) Workforce Survey and identify factors related to compensation of pediatric psychologists. Methods All full members of SPP ( n = 1,314) received the online Workforce Survey; 404 (32%) were returned with usable data. The survey assessed salary, benefits, and other income sources. The relationship between demographic and employment-related factors and overall compensation was explored. Results Academic rank, level of administrative responsibility, and cost of living index of employment location were associated with compensation. Compensation did not vary by gender; however, women were disproportionately represented at the assistant and associate professor level. Conclusions Compensation of pediatric psychologists is related to multiple factors. Longitudinal administration of the Workforce Survey is needed to determine changes in compensation and career advancement for this profession over time. Strategies to increase the response rate of future Workforce Surveys are discussed.
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Affiliation(s)
- Cheryl L. Brosig
- Medical College of Wisconsin and Children’s Hospital of Wisconsin
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14
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Wysocki T, Brosig CL, Hilliard ME. Society of Pediatric Psychology Workforce Survey: Development of Survey Methods, Sample Characteristics, and Lessons Learned. Clin Pract Pediatr Psychol 2017; 4:74-83. [PMID: 28066693 DOI: 10.1037/cpp0000134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are few detailed workforce studies of specialty fields within professional psychology, and none have been reported for pediatric psychology since 2006. Availability of such data could facilitate more-informed decision making by students and trainees, psychologists pursuing employment opportunities, and psychologists involved in employment or compensation negotiations. This article describes the work of a task force of the American Psychological Association (APA) Division 54 (Society of Pediatric Psychology) in the design, construction, pretesting, distribution, and data management for the Society of Pediatric Psychology (SPP) Workforce Survey. The 18-member task force was established to design and implement a workforce survey that balanced needs for breadth, clarity, brevity, and protection of confidentiality. The survey solicits information about demographic characteristics; training, licensure and certifications; employment settings, responsibilities, and productivity metrics; compensation; and employment satisfaction. A survey link was distributed via e-mail to full members of the SPP in June 2015. A total of 404 members (32.3% return rate) completed the survey. This article focuses on the development, methodology, and respondent characteristics for this 1st administration of the workforce survey. Separate articles will report detailed analyses of the survey results such as compensation and work satisfaction. Future distributions of the survey will enable compilation of a longitudinal database to track changes in the profession. SPP members and others may propose additional analyses of these data. This work may provide guidance to other groups of specialized psychologists who may wish to implement similar initiatives.
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Affiliation(s)
- Tim Wysocki
- Nemours Children's Health System, Jacksonville, Florida
| | - Cheryl L Brosig
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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15
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Abstract
BACKGROUND Practitioners who work with children with posterior fossa, facial hemangiomas, arterial anomalies, cardiovascular anomalies, and abnormalities of the eye (PHACE) syndrome need information about neurodevelopmental outcomes to provide appropriate anticipatory guidance and education for parents. This study aimed to determine the neurodevelopmental outcomes in children with PHACE syndrome and identify which children may be at greatest risk for delays. METHODS Children with a diagnosis of PHACE syndrome (ages 4-18 yrs) were recruited from the PHACE Syndrome International Clinical Registry and Genetic Repository. Participants (n = 25) underwent a neurodevelopmental evaluation at a children's hospital tertiary care referral center between 2009 and 2013. Children completed standardized neurocognitive tests assessing multiple domains. Parents completed standardized questionnaires assessing behavioral and emotional functioning. RESULTS Results were analyzed according to cohort and individual subject. Mean scores for the cohort did not differ significantly from test norms in most domains. The only subtest that the cohort scored lower on than test norms was Word Structure, a language task. Forty-four percent of the sample scored within the normal range in all domains, 28% had one score in the at-risk range (1-2 standard deviations [SDs] below the mean), 12% had two or more scores in the at-risk range, and 16% had at least one score in the impaired range (>2 SDs below the mean). CONCLUSION Although most children in this cohort of patients with PHACE syndrome did not have significant neurodevelopmental deficits, a subset of patients had delays in multiple areas. Practitioners who work with these children should routinely ask about neurocognitive and developmental skills. Children with more severe phenotypes should be referred for appropriate evaluations and intervention services.
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Affiliation(s)
- Cheryl L Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn H Siegel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita N Haggstrom
- Department of Dermatology, School of Medicine, Indiana University, Bloomington, Indiana.,Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Beth A Drolet
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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16
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Hoffman GM, Brosig CL, Bear LM, Tweddell JS, Mussatto KA. Effect of Intercurrent Operation and Cerebral Oxygenation on Developmental Trajectory in Congenital Heart Disease. Ann Thorac Surg 2015; 101:708-16. [PMID: 26542436 DOI: 10.1016/j.athoracsur.2015.08.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/13/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Children with congenital heart disease are at increased risk of abnormal neurodevelopment (ND). Demographic and perioperative physiologic factors have both been associated with developmental outcome. The acute physiologic effect of a surgical procedure, anesthesia, and hospitalization may offset any potential advantage gained from anatomic correction and circulatory palliation. The specific risk/benefit balance on ND outcome of the insult of the operation, offset by the benefit of improved anatomy and physiology, has not been addressed. We therefore sought to identify interval procedural and physiologic factors assessed at outpatient ND evaluation visits that were associated with outcome. METHODS The study included children with congenital heart disease at high risk for impaired ND performance with at least three ND assessments using the Bayley Scales of Infant Development-III during the first 3 years of life. The number of cardiac procedures, duration of hospitalization, feeding status, height, weight, and arterial, cerebral, and somatic oxygen saturations by near-infrared spectroscopy were recorded at each visit and used as predictors of language, motor, and cognitive composite scores and slopes (change over time) in general linear models. RESULTS Data on 178 children derived from 632 visits (median, 4 visits/child) were analyzed, with ages at first and last assessment of 7.7 and 30.2 months. Fifty-one had 1 ventricle (1V), 88 had 2 ventricles, and 39 had genetic syndrome conditions. Motor performance increased with age in all diagnostic categories. Cognitive and language performance increased with age in 1V patients but exhibited no significant change in 2-ventricle and genetic syndrome groups. At the first visit, 1V patients performed less well than 2-ventricle patients in the motor domain, but the rate of improvement was higher for 1V patients; by 24 months, there were no differences, and both groups were normal in all domains. Performance in genetic syndrome patients was below normal in all domains at the first visit and did not improve. Higher arterial saturation and narrower arterial-cerebral and arterial-somatic near-infrared spectroscopy saturation differences were associated with better or improving motor performance. Incremental cardiopulmonary bypass time, cumulative hospital length of stay, and tube feedings were risk factors in all domains. Total and incremental times for deep hypothermic circulatory arrest, extracorporeal membrane oxygenation, total open and total surgical procedures, and birth weight were not risk factors. CONCLUSIONS Patient physiologic status assessed by cerebral and somatic near-infrared spectroscopy is associated with ND performance. Incremental surgical procedures are not associated with ND performance when adjusted for cardiopulmonary bypass time and physiologic status. Treatment strategies that target improved physiologic status may also improve ND outcome.
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Affiliation(s)
- George M Hoffman
- Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Cheryl L Brosig
- Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laurel M Bear
- Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James S Tweddell
- Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Departments of Pediatric Anesthesiology, Pediatrics, and Pediatric Critical Care Medicine, Cardiology, and Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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17
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Hoffman GM, Brosig CL, Mussatto KA, Tweddell JS, Ghanayem NS. Perioperative cerebral oxygen saturation in neonates with hypoplastic left heart syndrome and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 2013; 146:1153-64. [DOI: 10.1016/j.jtcvs.2012.12.060] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 11/23/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
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19
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Brosig CL, Whitstone BN, Frommelt MA, Frisbee SJ, Leuthner SR. Psychological distress in parents of children with severe congenital heart disease: the impact of prenatal versus postnatal diagnosis. J Perinatol 2007; 27:687-92. [PMID: 17717519 DOI: 10.1038/sj.jp.7211807] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate coping and psychological functioning of parents of children prenatally or postnatally diagnosed with congenital heart disease. STUDY DESIGN Parents of 10 infants prenatally diagnosed by fetal echocardiogram and 7 infants postnatally diagnosed with severe congenital heart disease completed the Brief Symptom Inventory (BSI) at the time of diagnosis, at the time of birth and 6 months after birth. Prenatal and postnatal groups were compared to each other and to BSI norms. RESULT Although both groups scored higher than test norms at the time of diagnosis, they did not differ significantly from each other. Six months after birth, the postnatal group scores did not differ from test norms, but the prenatal group scores were still significantly higher than test norms. The severity of the child's heart lesion at diagnosis was related to parental distress levels; parents with children with more severe lesions had higher BSI scores. CONCLUSION Results suggest the need to provide parents with psychological support, regardless of the timing of diagnosis. Parents of children with more severe lesions may be at risk for higher levels of psychological distress, particularly over time.
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Affiliation(s)
- C L Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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20
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Abstract
OBJECTIVE The purpose of this study was to identify factors important to parents in their infant's end-of-life care. STUDY DESIGN Participants were parents (n=19 families) whose infant (less than 1 year old) had died. Parents completed the Revised Grief Experience Inventory (RGEI) and a semi-structured interview regarding their infant's end-of-life care. Interviews were rated using the Post-Death Adaptation Scale (PDAS). RESULTS Parents scored significantly lower than the normative sample on the RGEI, and PDAS scores suggested that these parents were adapting positively. Parent interviews identified the aspects of care that were important to parents: honesty, empowered decision-making, parental care, environment, faith/trust in nursing care, physicians bearing witness and support from other hospital care providers. CONCLUSIONS Results of this study suggest that parents can effectively cope following the death of an infant and the medical staff can do much to improve the end-of-life care for infants and their families.
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Affiliation(s)
- C L Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53201, USA
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21
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Brosig CL, Mussatto KA, Kuhn EM, Tweddell JS. Psychosocial outcomes for preschool children and families after surgery for complex congenital heart disease. Pediatr Cardiol 2007; 28:255-62. [PMID: 17486393 DOI: 10.1007/s00246-006-0013-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/21/2006] [Indexed: 11/29/2022]
Abstract
The purpose of the current study was to assess the psychosocial outcomes of preschool-aged survivors (ages 3-6 years) of hypoplastic left heart syndrome (HLHS; n=13) and transposition of the great arteries (TGA; n=13). Parents completed the following measures: Pediatric Quality of Life Inventory, Impact on the Family Scale, Parenting Stress Index, Parent Behavior Checklist, and Child Behavior Checklist. Quality of life scores did not differ from those of healthy controls. Parents of children with HLHS reported more negative impact of the child's illness on the family and more parenting stress than parents of children with TGA. Parents of both groups of children were more permissive in their parenting style than parents of healthy controls. Children with HLHS had higher rates of attention and externalizing behavior problems than children with TGA. The results highlight the need for practitioners working with these children and families to ask about parental stress, family functioning, and behavioral expectations for the child in the context of routine medical/cardiac follow-up.
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Affiliation(s)
- C L Brosig
- Department of Pediatrics, Medical College of Wisconsin, and Children's Hospital of Wisconsin, Herma Heart Center, Milwaukee, WI 53226, USA.
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22
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Brosig CL, Mussatto KA, Kuhn EM, Tweddell JS. Neurodevelopmental outcome in preschool survivors of complex congenital heart disease: implications for clinical practice. J Pediatr Health Care 2007; 21:3-12. [PMID: 17198894 DOI: 10.1016/j.pedhc.2006.03.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 03/22/2006] [Accepted: 03/23/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the neurodevelopmental outcome of preschool survivors of Hypoplastic Left Heart Syndrome (HLHS) and Transposition of the Great Arteries (TGA) in the modern surgical era. METHODS A cross-sectional design was used to evaluate 26 children (13 HLHS, 13 TGA), ages 3.5 to 6 years, at a Midwestern children's hospital. Measures included McCarthy Scales of Children's Abilities, Woodcock Johnson III Tests of Achievement, Developmental Test of Visual-Motor Integration, Receptive One-Word Vocabulary Test, Expressive One-Word Vocabulary Test, and Child Behavior Checklist. RESULTS Although intelligence quotient scores fell within the average range for both groups (TGA=110.5 vs. HLHS=97), the difference between groups was clinically meaningful (effect size= .79). The HLHS group showed more problems than did the TGA group with visual-motor skills, expressive language, attention, and externalizing behavior. DISCUSSION Results suggest that even in the modern surgical era, regular developmental screening for these patients is critical. Pediatric nurse practitioners play an important role in educating parents about the potential developmental risks to these children.
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Affiliation(s)
- Cheryl L Brosig
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee,Wisconsin, USA
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23
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Brosig CL, Zahrt DM. Evolution of an Inpatient Pediatric Psychology Consultation Service: Issues Related to Reimbursement and the Use of Health and Behavior Codes. J Clin Psychol Med Settings 2006. [DOI: 10.1007/s10880-006-9047-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hoffman GM, Mussatto KA, Brosig CL, Ghanayem NS, Musa N, Fedderly RT, Jaquiss RDB, Tweddell JS. Systemic venous oxygen saturation after the Norwood procedure and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 2005; 130:1094-100. [PMID: 16214525 DOI: 10.1016/j.jtcvs.2005.06.029] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 06/16/2005] [Accepted: 06/28/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Neonates with hypoplastic left heart syndrome have impaired systemic oxygen delivery and also have a high risk of hypoxic ischemic brain injury with resultant neurodevelopmental impairment. We hypothesized that decreased postoperative oxygen delivery, as measured on the basis of systemic venous oxyhemoglobin saturation, would be related to persistent neurodevelopmental abnormality assessed in childhood. METHODS Early perioperative hemodynamic data, prospectively acquired from neonates undergoing staged palliation of hypoplastic left heart syndrome by using deep hypothermic circulatory arrest with uniform perioperative management, were tested for relationship to later neurodevelopmental outcome assessed at age 4 years. RESULTS Complete hemodynamic and neurodevelopmental data were available in 13 patients aged 7 +/- 8 days at the time of the Norwood procedure and aged 4.5 +/- 0.7 years at follow-up assessment. The subjects scored significantly below the population mean for motor, visual-motor integration, and composite neurodevelopmental outcomes. The 5 (38%) patients with abnormal outcomes had significantly lower postoperative systemic venous oxygen saturation values than those with normal outcomes (46% +/- 8% vs 56% +/- 6%, P = .024). Standard hemodynamic parameters did not differentiate patient outcomes. The risk of abnormal outcome increased with increasing time at a systemic venous oxygen saturation of less than 40% (P < .001). A multivariate model of deep hypothermic circulatory arrest time, systemic venous oxygen saturation, blood pressure, and carbon dioxide tension accounted for 79% of the observed variance (P < .001). CONCLUSIONS Decreased systemic oxygen delivery in the neonatal postoperative period is associated with hypoxic-ischemic brain injury and childhood neurodevelopmental abnormality. Measures of systemic oxygen delivery should be used to guide perioperative strategies to reduce the risk of hypoxic-ischemic brain injury.
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Affiliation(s)
- George M Hoffman
- Department of Pediatric Anesthesiology, Medical College of Wisconsin, Milwaukee, Wis, USA.
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25
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Abstract
Although lung transplants are performed in children, experience with the pediatric population remains limited. There is growing interest in studying the psychological functioning and quality of life in these patients following transplant. There is a body of literature about quality of life in adult lung transplant recipients, but little is known about how pediatric patients and their families function psychologically after transplant. The current article summarizes the pediatric literature with respect to psychological outcomes for transplant recipients and their parents and points to areas where additional research is needed.
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Affiliation(s)
- Cheryl L Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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