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Behaviour at eight years in children with surgically corrected transposition: The Boston Circulatory Arrest Trial*

Published online by Cambridge University Press:  11 December 2008

David C. Bellinger ,
Jane W. Newburger ,
David Wypij ,
Karl C. K. Kuban ,
Adre J. duPlesssis  and
Leonard A. Rappaport
David C. Bellinger*
Affiliation:
Department of Neurology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts, United States of America
Jane W. Newburger
Affiliation:
Department of Cardiology, Children’s Hospital Boston, Boston, Massachusetts, United States of America Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
David Wypij
Affiliation:
Department of Cardiology, Children’s Hospital Boston, Boston, Massachusetts, United States of America Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
Karl C. K. Kuban
Affiliation:
Department of Neurology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts, United States of America
Adre J. duPlesssis
Affiliation:
Department of Neurology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts, United States of America
Leonard A. Rappaport
Affiliation:
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America Department of Medicine, Children’s Hospital Boston, Boston, Massachusetts, United States of America
*
Correspondence to: David C. Bellinger, Farley Basement Box 127, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Tel: 01 617 355 6565; Fax: 01 617 730 0618; E-mail: david.bellinger@childrens.harvard.edu
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Abstract

Uncertainty exists regarding the degree to which infants with congenitally malformed hearts are at risk of behavioural disorders in childhood. Data was collected as part of a randomized clinical trial involving 155 children with surgically corrected transposition (concordant atrioventricular and ventriculo-arterial connections or alignments). As infants, they underwent the arterial switch operation, involving deep hypothermia with predominantly total circulatory arrest or predominantly low-flow continuous cardiopulmonary bypass as the method of providing support to the vital organs. Parents completed the Child Behavior Checklist when the patients were aged 4 and 8 years, and the Connors’ Parent Rating Scale at the age of 8 years. When the children were aged 8, teachers completed the Teacher’s Report Form and the Connors’ Teacher Rating Scale. In the cohort as a whole, the frequencies of behavioural problems identified by both parents and teachers were elevated, particularly on the scales for competence of the Child Behavior Checklist, and the Adaptive scales of the Teacher’s Report Form. Approximately 1 in 5 patients had scores for Total Problem Behavior in the range of clinical concern on both the Child Behavior Checklist and the Teacher’s Report Form. Few differences were found, however, according to the method of operative treatment. Postoperative seizures were associated with social and attention problems. Children experiencing academic problems at the age of 8 showed a larger increase in behavioural problems between the ages of 4 and 8 than did children making adequate academic progress. Children with congenitally malformed hearts who underwent reparative surgery in infancy using a strategy of severe haemodilution and alpha stat are at increased risk of behavioural problems in middle childhood.

Keywords

Discordant ventriculo-arterial connectionscongenital heart diseasepsychosocial outcomesparent ratingsteacher ratingsrandomized trial
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 1 , February 2009 , pp. 86 - 97
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

*

Supported by NIH grants HL41786, RR02172, and P30-HD18655.

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