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Published on: July 18, 2014
School-Age Test Proficiency and Special Education After Congenital Heart Disease Surgery in Infancy
Sarah B Mulkey1, Shasha Bai2, Chunqiao Luo2
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR; Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR.
Insights
Children who had surgery for congenital heart disease (CHD) before age one demonstrate lower academic achievement and require more special education services. These findings highlight the importance of developmental assessments for these children.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Educational Psychology
Background:
- Congenital heart disease (CHD) affects a significant number of newborns, requiring early surgical intervention.
- Long-term neurodevelopmental outcomes and educational attainment in children with CHD are critical areas of research.
- Early surgery for CHD may impact cognitive development and academic performance.
Purpose of the Study:
- To assess academic proficiency in school-aged children who underwent surgery for CHD in infancy.
- To determine the rate of special education service receipt among children with a history of early CHD surgery.
- To identify factors associated with academic achievement in this population.
Main Methods:
- Utilized a longitudinal database linking surgical records of children with CHD (born 1996-2004, surgery <1 year) to educational achievement test scores and special education data.
- Employed logistic regression to analyze associations between academic proficiency and demographic, maternal education, and clinical variables.
- Compared academic performance and special education receipt in children with CHD to grade-matched state peers.
Main Results:
- Children with CHD showed lower proficiency in literacy and mathematics compared to state peers.
- Higher 5-minute Apgar scores, shorter hospitalizations, and higher maternal education predicted literacy proficiency.
- White race, absence of cardiopulmonary bypass, and shorter hospitalizations predicted mathematics proficiency.
- Children with CHD were significantly more likely to receive special education services (26.9% vs. 11.6%).
Conclusions:
- Children with CHD undergoing early surgery experience poorer academic outcomes.
- Increased need for special education services is evident in children with a history of CHD.
- Routine neurodevelopmental evaluations are recommended for all children with CHD.
Objective:
To evaluate test proficiency and the receipt of special education services in school-age children who had undergone surgery for congenital heart disease (CHD) at age <1 year.
Study Design:
Data from Arkansas-born children who underwent surgery for CHD at Arkansas Children's Hospital at age <1 year between 1996 and 2004 were linked to state birth certificates and the Arkansas Department of Education longitudinal database containing achievement test scores in literacy and mathematics for grades 3-4 and special education codes. The primary negative outcome was not achieving grade-level proficiency on achievement tests. Logistic regression accounting for repeated measures was used to evaluate for associations between achieving proficiency and demographic data, maternal education, and clinical factors.
Results:
A total of 362 of 458 (79%) children who underwent surgery for CHD were matched to the Arkansas Department of Education database, 285 of whom had grade 3 and/or 4 achievement tests scores. Fewer students with CHD achieved proficiency in literacy and mathematics (P < .05) compared with grade-matched state students. Higher 5-minute Apgar score, shorter duration of hospitalization, and higher maternal education predicted proficiency in literacy (P < .05). White race, no cardiopulmonary bypass, and shorter hospitalization predicted proficiency in mathematics (P < .05). Sex, gestational age, age at surgery, CHD diagnosis, and type and number of surgeries did not predict test proficiency. Compared with all public school students, more children with CHD received special education services (26.9% vs 11.6%; P < .001).
Conclusion:
Children with CHD had poorer academic achievement and were more likely to receive special education services than all state students. Results from this study support the need for neurodevelopmental evaluations as standard practice in children with CHD.
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