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Academic proficiency in children after early congenital heart disease surgery.

ABSTRACT: Children with early surgery for congenital heart disease (CHD) are known to have impaired neurodevelopment; their performance on school-age achievement tests and their need for special education remains largely unexplored. The study aimed to determine predictors of academic achievement at school age and placement in special education services among early CHD surgery survivors. Children with CHD surgery at <1 year of age from January 1, 1998 to December 31, 2003, at the Arkansas Children's Hospital were identified. Out-of-state births and infants with known genetic and/or neurologic conditions were excluded. Infants were matched to an Arkansas Department of Education database containing standardized assessments at early school age and special-education codes. Predictors for achieving proficiency in literacy and mathematics and the receipt of special education were determined. Two hundred fifty-six children who attended Arkansas public schools and who had surgery as infants were included; 77.7 % had either school-age achievement-test scores or special-education codes of mental retardation or multiple disabilities. Scores on achievement tests for these children were 7-13 % lower than those of Arkansas students (p < 0.01). They had an eightfold increase in receipt of special education due to multiple disabilities [odds ratio (OR) 10.66, 95 % confidence interval (CI) 4.23-22.35] or mental retardation (OR 4.96, 95 % CI 2.6-8.64). Surgery after the neonatal period was associated with decreased literacy proficiency, and cardiopulmonary bypass during the first surgery was associated with decreased mathematics proficiency. Children who had early CHD surgery were less proficient on standardized school assessments, and many received special education. This is concerning because achievement-test scores at school age are "real-world" predictors of long-term outcomes.

SUBMITTER: Mulkey SB

PROVIDER: S-EPMC3946912 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Academic proficiency in children after early congenital heart disease surgery.

Mulkey Sarah B SB Swearingen Christopher J CJ Melguizo Maria S MS Reeves Rachel N RN Rowell Jacob A JA Gibson Neal N Holland Greg G Bhutta Adnan T AT Kaiser Jeffrey R JR

Pediatric cardiology 20130903 2

Children with early surgery for congenital heart disease (CHD) are known to have impaired neurodevelopment; their performance on school-age achievement tests and their need for special education remains largely unexplored. The study aimed to determine predictors of academic achievement at school age and placement in special education services among early CHD surgery survivors. Children with CHD surgery at <1 year of age from January 1, 1998 to December 31, 2003, at the Arkansas Children's Hospit ...[more]

PMID: 24000004

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Project description:BACKGROUND:The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). METHODS:We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children's Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0-1?months old), infants (1-12?months old) and children (1-10?years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. RESULTS:A total of 11,651 subjects were included in the study. The overall nosocomial infection rate was 10.8%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 32.9, 15.4, and 5.2%, respectively. Multivariate logistic regression analysis found age (OR 0798, 95%CI: 0.769-0.829; P?<?0.001), STS risk grade (OR 1.267, 95%CI: 1.159-1.385; P?<?0.001), body mass index (BMI) <5th percentile (OR 1.295, 95%CI: 1.023-1.639; P?=?0.032), BMI >95th percentile (OR 0.792, 95%CI: 0.647-0.969; P?=?0.023), cardiopulmonary bypass (CPB) time (OR 1.008, 95%CI: 1.003-1.012; P?<?0.001) and aortic clamping time (OR 1.009, 1.002-1.015; P?=?0.008) were significantly associated with nosocomial infection in CHD infants. After adjusted for confounding factors, we found STS risk grade (OR 1.38, 95%CI: 1.167-1.633; P?<?0.001), BMI?<?5th percentile (OR 1.934, 95%CI: 1.377-2.715; P?<?0.001), CPB time (OR 1.018, 95%CI: 1.015-1.022; P?<?0.001), lymphocyte/WBC ratio<cut off value (OR 3.818, 95%CI: 1.529-9.533; P?=?0.004) and AST>cut off value (OR 1.546, 95%CI: 1.119-2.136; P?=?0.008) were significantly associated with nosocomial infection in CHD children. CONCLUSION:Our study suggested STS risk grade, BMI, CPB duration, low lymphocyte/WBC or high neutrophil/WBC ratio were independently associated with nosocomial infection in CHD infant and children after cardiac surgery.

Project description:OBJECTIVE: Totally endoscopic surgery compared with the conventional heart operation in children is described in this article to find a preferable treatment for congenital heart diseases. METHODS: Between May 2000 and December 2007, 708 children with congenital heart disease were divided into two groups: endoscopic group and conventional group. For the endoscopic group, all children underwent total endoscopic procedures with peripheral cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia, whereas for the conventional group, all children were operated in traditional way. Three 1-2-cm intercostal ports in the right chest were used for access in the endoscopic group. The intrathoracic part of the operation was performed completely under two-dimensional video, using conventional instruments. Directly closureed of the atrial septal defect was performed in 74 cases, patch closureed of the atrial septal defect in 48 cases, directly closureed of the ventricular septal defect in 158 cases, patch closureing of the ventricular septal defect in 116 cases. For the conventional group, all operations were done with traditional median sternotomy. Directed closureing of the atrial septal defect was performed in 38 cases, patch closed of the atrial septal defect in 56 cases, directly closureed of the ventricular septal defect in 76 cases, patch closureed of the ventricular septal defect in 142 cases. RESULTS: There was no hospital mortality in both groups. For the endoscopic group, operations were performed successfully in 390 (98.5 %) patients, enlarging a port to a 5-cm incision in 4 children. Reoperation was necessary in two children, and no conversion to median sternotomy incision was necessary. The mean duration of operation was 132 ± 48 min, and cardiopulmonary bypass and aortic cross-clamp times were 54 ± 16 min and 25 ± 8 min, respectively. Major postoperative complications occurred in nine (2.3 %, p < 0.05) cases. For the conventional group, all children were operated by median sternotomy, and the mean duration of operation was 118 ± 41 min (p < 0.05); cardiopulmonary bypass and aortic cross-clamp times were 51 ± 13 min and 21 ± 6 min (p < 0.05), respectively. Major postoperative complications occurred in 16 (5.1 %) cases. Also, the intensive care unit stay time (8.3 ± 2.8 h versus 8.9 ± 2.9 h, p < 0.01), postoperative drainage (120 ± 21 ml versus 433 ± 140 ml, p < 0.05), and hospital time (8.6 ± 1.8 days versus 11.5 ± 1.9 days, p < 0.05) were statistically different. CONCLUSIONS: Totally endoscopic closed chest congenital heart surgery in children was feasible and safe. The results were similar or even superior to the traditional operations due to the decreased use of blood products and shortened hospital time. Degree of satisfaction with cosmetic result and postoperative comfort were very high. Therefore, endoscopic surgery will become a new popular choice for some congenital heart disease patients in the future.

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Academic proficiency in children after early congenital heart disease surgery.

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Academic proficiency in children after early congenital heart disease surgery.

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