Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e759-e767 (doi:10.1542/peds.2007-1066)

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ARTICLE

Inattention, Hyperactivity, and School Performance in a Population of School-Age Children With Complex Congenital Heart Disease

Amanda J. Shillingford, MD^a, Marianne M. Glanzman, MD^b, Richard F. Ittenbach, PhD^c, Robert R. Clancy, MD^d, J. William Gaynor, MD^e and Gil Wernovsky, MD^a

^a Divisions of Cardiology
^b Child Development and Rehabilitation
^c Biostatistics and Data Management Core
^e Cardiothoracic Surgery
^d Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

INTRODUCTION. There is a growing interest in characterizing the neurodevelopmental outcomes of school-age survivors of cardiac surgery. The purpose of this study was to examine a population of 5- to 10-year-old children who underwent newborn cardiac surgery for complex congenital heart disease to characterize and assess risk factors for problems with inattention and hyperactivity, as well as the use of remedial school services.

PATIENTS AND METHODS. This study was a cross-sectional analysis of patients who underwent newborn cardiac surgery and were enrolled in a neuroprotection trial conducted at our institution between 1992 and 1997. Parents and teachers completed questionnaires for the school-age child to elicit information pertaining to the child's general health and academic performance. The severity of hyperactivity and inattention were assessed by using 2 standardized questionnaires (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV and Behavior Assessment System for Children). In addition to calculating descriptive estimates of their occurrence, single-covariate logistic regression models were specified and tested by using 3 different outcomes (inattention, hyperactivity, and use of remedial school services) and 14 different covariates representing preoperative, intraoperative, and postoperative factors.

RESULTS. Data were obtained from parents and/or teachers for 109 children. Fifty-three (49%) were receiving some form of remedial academic services, and 15% were assigned to a special-education classroom. The number of children receiving clinically significant scores for inattention and hyperactivity on the Behavior Assessment System for Children was 3 to 4 times higher than observed in the general population. On the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, 30% of the parents reported high-risk scores for inattention and 29% reported high-risk scores for hyperactivity. No perioperative factors were statistically associated with adverse outcomes.

CONCLUSION. In this cohort of children with complex congenital heart disease, a significant proportion of the children were at risk for inattention and hyperactivity, and nearly half were using remedial school services. We did not identify any perioperative risk factors, which correlated with high-risk scores or the use of remedial school services. Ongoing neurodevelopmental follow-up and screening are recommended in this vulnerable population.

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Key Words: congenital heart disease • ADHD • congenital heart disease outcomes • school performance • deep hypothermic circulatory arrest

Abbreviations: CHD—congenital heart disease • CPB—cardiopulmonary bypass • DHCA—deep hypothermic circulatory arrest • BASC—Behavior Assessment System for Children • ADHD-IV—Attention-Deficit/Hyperactivity Disorder Rating Scale-IV • ADHD—attention-deficit/hyperactivity disorder

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Accepted Sep 5, 2007.

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