Related Experiment Video
Updated: Jun 8, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Behaviour Concerns in Preschool Cardiac Surgery Survivors
Sabrina H Y Eliason1,2, Charlene M T Robertson1,2, Susan A Bobbitt3
1Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Insights
Behaviour concerns in children after complex cardiac surgery are linked to noncardiac hospitalizations. Addressing these hospitalizations may improve behavioral outcomes for these survivors.
Area of Science:
- Pediatric Cardiology
- Developmental Psychology
- Health Services Research
Background:
- Behaviour concerns (BC) are noted in survivors of complex cardiac surgery (CCSx), but factors influencing these outcomes are not well-established.
- Evidence regarding health and demographic variables impacting BC in CCSx survivors is inconsistent.
- Understanding predictors of BC is crucial for targeted interventions in this vulnerable population.
Purpose of the Study:
- To identify demographic, acute care, and health factors predicting behavior concerns in infants following complex cardiac surgery.
- To evaluate the association between various clinical and social variables and behavioral outcomes at preschool age.
- To inform strategies for improving long-term neurodevelopmental outcomes in pediatric cardiac surgery survivors.
Main Methods:
- A prospective inception-cohort study included 585 infants without chromosomal abnormalities undergoing CCSx between 2001 and 2017.
- Behavioral outcomes were assessed at 4.5 years using parent rating scales from the Behaviour Assessment System for Children (BASC-II/III).
- Multiple logistic regression identified independent predictors of externalizing, internalizing behaviors, adaptive functioning, and overall behavioral symptoms.
Main Results:
- Noncardiac hospitalizations independently predicted increased odds of externalizing behaviors (OR: 1.10), internalizing behaviors (OR: 1.14), and overall behavioral symptoms (OR: 1.10).
- Female sex and single ventricle physiology were associated with higher odds of internalizing behaviors.
- Lower socioeconomic status and fewer years of maternal schooling predicted poorer adaptive behavior, while extracorporeal life support predicted more pervasive behavioral symptoms.
Conclusions:
- The number of noncardiac hospitalizations is a significant predictor of increased behavior concerns in children after complex cardiac surgery.
- Interventions aimed at reducing noncardiac hospitalizations, such as improving trauma-informed care and primary care access, may mitigate behavioral issues.
- Further research and clinical attention are warranted to address modifiable factors impacting behavioral outcomes in this population.
Background:
Behaviour concerns (BC) are reported in survivors of complex cardiac surgery (CCSx) with inconsistent evidence about health and demographic variables that impact outcomes.
Methods:
A prospective inception-cohort study of infants (without known chromosomal abnormalities) after CCSx from 2001 to 2017 determined Behaviour Assessment System for Children (BASC-II/III) parent rating scales at 4.5 years. T scores ≥60 for externalizing, internalizing, and the Behavioural Symptoms Index and ≤40 for adaptive behaviour defined BC. Potential predictive variables included demographic, acute care, and health factors after initial CCSx. Multiple logistic regression using the purposeful selection method gave odds ratios (ORs) with 95% confidence intervals (CIs).
Results:
Survivors (n = 585; 61% boys, 40% single ventricle) were assessed at a median age of 55 months (interquartile range: 53, 57 months). Independent predictors were noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; P = 0.015) for externalizing; noncardiac hospitalizations (OR: 1.14, 95% CI: 1.05, 1.24; P = 0.003), female sex (OR: 1.62, 95% CI: 1.04, 2.52; P = 0.031), and single ventricle (OR: 1.82, 95% CI: 1.04, 3.17; P = 0.035) for internalizing; noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; P = 0.017), socioeconomic status (SES) (OR: 0.98, 95% CI: 0.96, 0.10; P = 0.031), and years of maternal schooling (OR: 0.91, 95% CI: 0.84, 0.10; P = 0.04) for adaptive; and extracorporeal life-saving support (OR: 2.03, 95% CI: 1.01, 3.96; P = 0.041) for the Behavioural Symptoms Index, indicating more pervasive behaviours.
Conclusions:
The number of noncardiac hospitalizations predicted increased odds of BC and requires further attention. Improving inpatient trauma-informed care experiences and optimizing access to primary care to prevent noncardiac hospitalization may be modifiable.
Related Concept Videos
01:24Operant Conditioning Intervention
In operant conditioning, behaviors that are...
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:28Conduct Disorder
01:19Autism Spectrum Disorder
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.