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Behaviour at eight years in children with surgically corrected transposition: The Boston Circulatory Arrest Trial
David C Bellinger1, Jane W Newburger, David Wypij
1Department of Neurology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. david.bellinger@childrens.harvard.edu
Insights
Children with congenital heart defects who had surgery in infancy face higher risks of behavioral disorders. This study found elevated behavioral problems in middle childhood, impacting social and academic functioning.
Area of Science:
- Pediatric Cardiology
- Developmental Psychology
- Pediatric Surgery
Background:
- Congenital heart defects (CHDs) affect numerous infants, with surgical correction being standard.
- Long-term neurodevelopmental outcomes, particularly behavioral risks, following infant cardiac surgery remain incompletely understood.
Purpose of the Study:
- To investigate the risk of childhood behavioral disorders in infants with surgically corrected transposition of the great arteries (TGA).
- To identify potential associations between surgical methods, postoperative complications, and behavioral outcomes.
Main Methods:
- A cohort of 155 children undergoing arterial switch operation for TGA in infancy was assessed.
- Parent and teacher-reported behavioral data were collected at ages 4 and 8 years using validated questionnaires (Child Behavior Checklist, Connors' Scales).
Main Results:
- Elevated frequencies of behavioral problems were observed in the cohort, particularly in competence and adaptive functioning.
- Approximately 20% of patients exhibited clinically concerning Total Problem Behavior scores.
- Postoperative seizures correlated with social and attention issues; academic difficulties predicted increased behavioral problems over time.
Conclusions:
- Infants with CHDs undergoing arterial switch surgery are at increased risk for behavioral problems in middle childhood.
- While surgical technique differences showed minimal impact, postoperative seizures and academic struggles are significant risk factors for behavioral issues.
Abstract:
Uncertainty exists regarding the degree to which infants with congenitally malformed hearts are at risk of behavioural disorders in childhood. Data was collected as part of a randomized clinical trial involving 155 children with surgically corrected transposition (concordant atrioventricular and ventriculo-arterial connections or alignments). As infants, they underwent the arterial switch operation, involving deep hypothermia with predominantly total circulatory arrest or predominantly low-flow continuous cardiopulmonary bypass as the method of providing support to the vital organs. Parents completed the Child Behavior Checklist when the patients were aged 4 and 8 years, and the Connors' Parent Rating Scale at the age of 8 years. When the children were aged 8, teachers completed the Teacher's Report Form and the Connors' Teacher Rating Scale. In the cohort as a whole, the frequencies of behavioural problems identified by both parents and teachers were elevated, particularly on the scales for competence of the Child Behavior Checklist, and the Adaptive scales of the Teacher's Report Form. Approximately 1 in 5 patients had scores for Total Problem Behavior in the range of clinical concern on both the Child Behavior Checklist and the Teacher's Report Form. Few differences were found, however, according to the method of operative treatment. Postoperative seizures were associated with social and attention problems. Children experiencing academic problems at the age of 8 showed a larger increase in behavioural problems between the ages of 4 and 8 than did children making adequate academic progress. Children with congenitally malformed hearts who underwent reparative surgery in infancy using a strategy of severe haemodilution and alpha stat are at increased risk of behavioural problems in middle childhood.