Published online October 18, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. e572-e576 (doi:10.1542/peds.2003-0983-L)
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ELECTRONIC ARTICLE

Prediction of IQ and Achievement at Age 8 Years From Neurodevelopmental Status at Age 1 Year in Children With D-Transposition of the Great Arteries

Ellen McGrath, RN*, David Wypij, PhD*,{ddagger},§,||, Leonard A. Rappaport, MD§,¶, Jane W. Newburger, MD, MPH*,§ and David C. Bellinger, PhD#,**

* Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts
{ddagger} Clinical Research Program, Children's Hospital Boston, Boston, Massachusetts
§ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
|| Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
# Department of Neurology, Children's Hospital Boston, Boston, Massachusetts
** Department of Neurology, Harvard Medical School, Boston, Massachusetts

Objective. Studies of developmental outcomes in children with congenital heart disease (CHD) frequently use assessments conducted in infancy as primary endpoints. Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated, however.

Methods. In the Boston Circulatory Arrest Study, 135 children with D-transposition of the great arteries repaired by arterial switch operation were administered the Bayley Scales of Infant Development and the Fagan Test of Infant Intelligence at 1 year of age and the Wechsler Intelligence Scale for Children, Third Edition and the Wechsler Individual Achievement Test at 8 years.

Results. Although most 1-year test scores were significantly associated with 8-year test scores, the amounts of shared variance were modest (<10%). All 1-year test scores had poor sensitivity (16%–32%) and poor positive predictive value (35%–42%) but good specificity (80%–93%) and negative predictive value (78%–79%). More than half of the children with low scores at 8 years (≤85) had had scores >84 at 1 year.

Conclusion. This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years, many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores. Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative, intraoperative, and postoperative factors.

Key Words: infant heart surgery • prediction • development • congenital heart defects

Abbreviations: BSID, Bayley Scales of Infant Development • DTGA, D-transposition of the great arteries • MDI, Mental Development Index • PDI, Psychomotor Development Index • CI, confidence interval • PPV, positive predictive value • NPV, negative predictive value • OR, odds ratio

Accepted Jun 2, 2004.




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