Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e478-e486 (doi:10.1542/10.1542/peds.2006-3250)

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ARTICLE

Neurocognitive, Functional, and Health Outcomes at 5 Years of Age for Children After Complex Cardiac Surgery at 6 Weeks of Age or Younger

Dianne E. Creighton, PhD, RPsych^a,b, Charlene M.T. Robertson, MD, FRCP(C)^c, Reg S. Sauve, MD, FRCP(C)^b, Diane M. Moddemann, MD, FRCP(C)^d, Gwen Y. Alton, BScN, RN^e, Alberto Nettel-Aguirre, PhD^f, David B. Ross, MD, FRCP(C)^g, Ivan M. Rebeyka, MD, FRCP(C)^c,g and the Western Canadian Complex Pediatric Therapies Follow-up Group

^a Cardiorespiratory Services, Alberta Children's Hospital, Calgary, Alberta, Canada
^b Department of Pediatrics
^f Research Methods Team, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of
^c Pediatrics
^g Surgery, University of Alberta, Edmonton, Alberta, Canada
^d Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
^e Division of Critical Care, Stollery Children's Hospital, Edmonton, Alberta, Canada

OBJECTIVE. This work provides neurocognitive, functional, and health outcomes for 5-year survivors of early infant complex cardiac surgery, including those with chromosomal abnormalities.

PATIENTS AND METHODS. Of 85 children (22.4% mortality), 61 received multidisciplinary, individual evaluation and parental questionnaires at 5 years. Full-scale, verbal, and performance IQ scores were compared by using analysis of variance among children who received different surgeries (arterial switch, 20; Norwood for hypoplastic left heart syndrome, 14; simple total anomalous pulmonary venous connection, 6; miscellaneous, 21; and chromosomal abnormalities, 8). Predictions from mental scores at 2 years for IQ scores at 5 years were determined.

RESULTS. Children with chromosomal abnormalities had lower full-scale and verbal IQs at 5 years than other survivors, with no differences found among the remaining groups. For children post-Norwood, performance IQ scores remained lower than for children after the arterial-switch operation. Prediction of full-scale IQ (<70) from 2-year mental scores for all 61 children were as follows: sensitivity, 87.5%; specificity, 88.1%; positive predictive value, 53.8%; and negative predictive value, 97.9%. For full-scale IQ of <85, predictions were 90.0%, 87.8%, 78.3%, and 94.7%, respectively. For those 53 without chromosomal abnormalities, full-scale IQ <70, respective predictions were 86.7%, 90.0%, 28.6%, and 97.8%, and for full-scale IQ <85, respective predictions were 85.7%, 89.7%, 75.0%, and 94.6%. Parental report indicated good health in 80% and adequate function in 67% to 88% of the children, although health-utilization numbers suggest that these reports are optimistic.

CONCLUSIONS. Five-year full-scale and verbal IQs were similar among groups, excluding those with chromosomal abnormalities. Children with chromosomal abnormalities had the lowest scores. Excluding those with chromosomal abnormalities, the mean mental scores for the children as a group tended to increase from 2 to 5 years of age, with an overall high percentage of correct classifications at 2 years.

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Key Words: heart • newborn • growth • development • intelligence

Abbreviations: WPPSI—Wechsler Scale of Preschool and Primary Intelligence • VMI—Visual Motor Integration • FSIQ—full-scale IQ • VIQ—verbal IQ • PIQ—performance IQ • MAHSC—Multiattribute Health Status Classification • MDI—Mental Development Index • PDI—Psychomotor Development Index

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Accepted Feb 16, 2007.

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