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Academic Outcomes in Children With Congenital Heart Defects: A Population-Based Cohort Study
Matthew E Oster1, Stephanie Watkins2, Kevin D Hill2
1From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (M.E.O); Department of Cardiology, Children's Healthcare of Atlanta, GA (M.E.O.); Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (M.E.O., J.H.K.); Department of Physical Therapy, Methodist University, Fayetteville, NC (S.W.); Department of Pediatrics, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC (K.D.H.); and Birth Defects Monitoring Branch, State Center for Health Statistics, North Carolina Division of Public Health, Raleigh (R.E.M.). osterm@kidsheart.com.
Insights
Children with congenital heart defects (CHD) face greater academic challenges, impacting reading and math performance. Early evaluation for exceptional services is crucial for all children with CHD.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Educational Psychology
Background:
- Previous research on neurocognitive outcomes in children with congenital heart defects (CHD) often focused on high-risk groups or utilized specialized assessments.
- There is a need to understand the broader academic implications of CHD beyond specialized testing.
Purpose of the Study:
- To investigate the association between congenital heart defects (CHD) and academic performance in elementary school.
- To compare academic outcomes based on the severity of CHD.
Main Methods:
- A retrospective cohort study linked North Carolina educational records with birth defects registry and vital records.
- Logistic regression analysis adjusted for demographic and educational factors.
- Examined third-grade reading and math end-of-grade examination results from 2006-2012.
Main Results:
- Children with CHD had increased odds (1.24x) of not meeting standards in reading or math compared to peers without CHD.
- Nearly 45% of children with CHD did not meet standards in at least one subject, versus 37.5% of controls.
- Children with critical CHD showed a higher likelihood of receiving exceptional services compared to those with noncritical CHD.
Conclusions:
- All children with any type of congenital heart defect (CHD) demonstrate poorer academic outcomes.
- Consideration for exceptional educational services is recommended for all children diagnosed with CHD.
Background:
Most studies evaluating neurocognitive outcomes in children with congenital heart defects (CHD) have focused on high-risk patients or used specialized, resource-intensive testing. To determine the association of CHD with academic outcomes and compare outcomes according to the severity of CHD, we linked state educational records with a birth defects registry and birth certificates.
Methods And Results:
We performed a retrospective cohort study using data from the North Carolina Birth Defects Monitoring Program, North Carolina Department of Public Instruction, and North Carolina Department of Health and Human Services vital records. We performed logistic regression, adjusting for maternal education, race/ethnicity, enrollment in public pre-Kindergarten, and gestational age, to determine the association of CHD with not meeting standards on reading and math end-of-grade examinations in third grade in 2006 to 2012. Of 5624 subjects with CHD and 10 832 with no structural birth defects, 2807 (50%) and 6355 (59%) were linked, respectively. Children with CHD had 1.24× the odds of not meeting standards in either reading or math (95% confidence interval, 1.12-1.37), with 44.6% of children with CHD not meeting standards in at least one of these areas compared with 37.5% without CHD. Although children with both critical and noncritical CHD had poorer outcomes, those with critical CHD were significantly more likely to receive exceptional services compared with the noncritical group (adjusted odds ratio, 1.46; 95% confidence interval, 1.15-1.86).
Conclusions:
Children with all types of CHD have poorer academic outcomes compared with their peers. Evaluation for exceptional services should be considered in children with any type of CHD.
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