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Published on: July 18, 2014
Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries
H H Hövels-Gürich1, K Konrad, M Wiesner
1Department of Paediatric Cardiology, Aachen University of Technology, Pauwelsstr. 30, D-52057 Aachen, Germany. hhoevels-guerich@ukaachen.de
Insights
Neonatal arterial switch operations for transposition of the great arteries are linked to parent-reported behavioral issues in children, but not reduced quality of life. Neurological status and endurance capacity predict stress related to illness.
Area of Science:
- Pediatric Cardiology
- Developmental Psychology
- Surgical Outcomes
Background:
- Transposition of the great arteries (TGA) is a critical congenital heart defect.
- Arterial switch operation (ASO) is the standard surgical repair for TGA in neonates.
- Long-term neurodevelopmental and psychosocial outcomes after neonatal ASO require further investigation.
Purpose of the Study:
- To assess behavioral outcomes and quality of life in children aged 8-14 years following neonatal arterial switch operation for TGA.
- To identify factors associated with adverse behavioral outcomes and quality of life post-surgery.
Main Methods:
- A cohort of 60 children who underwent neonatal ASO with deep hypothermic circulatory arrest and low-flow cardiopulmonary bypass were evaluated.
- Behavioral outcomes were assessed using the Child Behaviour Checklist (CBCL).
- Quality of life was evaluated using the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL).
Main Results:
- Parents reported worse behavioral outcomes across all CBCL measures (problems and competencies).
- Children did not report a reduced quality of life on IQCL scores compared to the general population.
- Multivariate analysis revealed associations between preoperative hypoxia, cardiocirculatory insufficiency, reduced expressive language, poor academic achievement, impaired neurological status, reduced endurance capacity, and specific behavioral problems or stress by illness.
Conclusions:
- Neonatal ASO is associated with long-term, parent-reported behavioral impairments but not a general reduction in self-reported quality of life.
- A discrepancy exists between parent and child perceptions of the child's well-being, potentially due to differing illness perceptions.
- Neurological impairment and reduced endurance capacity are key risk factors for long-term psychosocial maladjustment after neonatal corrective cardiac surgery.
Aims:
To evaluate behavioural outcome and quality of life in children aged 8-14 years after neonatal arterial switch operation for transposition of the great arteries.
Methods:
Sixty children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9-14.3 years by the Child Behaviour Checklist (CBCL) and the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL).
Results:
Parent reported behavioural outcome on all CBCL problem and competence scores was worse, whereas quality of life on self reported IQCL scores was not reduced compared to the normal population. On multivariate analysis, severe preoperative hypoxia was related to parent reported social problems; peri- and postoperative cardiocirculatory insufficiency was associated with internalizing, externalizing, attention, and total behavioural problems. Reduced expressive language was associated with total behavioural problems, and poor academic achievement was related to parent reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self reported stress by illness.
Conclusions:
The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life. This discrepancy may be a result of different perception of illness. In our experience, increased risk of long term psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.
