Neurocognitive, functional, and health outcomes at 5 years of age for children after complex cardiac surgery at 6 weeks of age or younger.
OBJECTIVE
This work provides neurocognitive, functional, and health outcomes for 5-year survivors of early infant complex cardiac surgery, including those with chromosomal abnormalities.


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.
Creighton
Dianne E
DE
Cardiorespiratory Services, Alberta Children's Hospital, Calgary, Alberta, Canada.
Robertson
Charlene M T
CM
Sauve
Reg S
RS
Moddemann
Diane M
DM
Alton
Gwen Y
GY
Nettel-Aguirre
Alberto
A
Ross
David B
DB
Rebeyka
Ivan M
IM
D006348:Cardiac Surgical Procedures; D002657:Child Development; D002675:Child, Preschool; D002869:Chromosome Aberrations; D005260:Female; D006304:Health Status; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires