title: Apolipoprotein E genotype modifies the risk of behavior problems after infant cardiac surgery.
abstract: OBJECTIVE
  The goal was to evaluate polymorphisms of the APOE gene as modifiers of neurobehavioral outcomes for preschool-aged children with congenital heart defects, after cardiac surgery.
  
  
  METHODS
  A prospective observational study with neurodevelopmental evaluation between the fourth and fifth birthdays was performed. Attention and behavioral skills were assessed through parental report.
  
  
  RESULTS
  Parents of 380 children completed the neurobehavioral measures. Child Behavior Checklist scores for the pervasive developmental problem scale were in the at-risk or clinically significant range for 15% of the cohort, compared with 9% for the normative data (P < .00001). Attention problem scores were in the at-risk or clinically significant range for 12% of the cohort, compared with 7% for the normative data (P = .0002). The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, Preschool Version, was completed for 378 children; 30% scored in the clinically significant range for inattention and 22% for impulsivity. After adjustment for covariates, the APOE epsilon2 allele was significantly associated with higher scores (worse problems) for multiple Child Behavior Checklist indices, including somatic complaints (P = .009), pervasive developmental problems (P = .032), and internalizing problems (P = .009). In each case, the epsilon4 allele was associated with a better outcome. APOE epsilon2 carriers had impaired social skills, compared with epsilon4 carriers (P = .009).
  
  
  CONCLUSIONS
  For preschool-aged children with congenital heart defects requiring surgery, parental rating scales showed an increased prevalence of restricted behavior patterns, inattention, and impaired social interactions. The APOE epsilon2 allele was associated with increased behavior problems, impaired social interactions, and restricted behavior patterns.
authors: Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. gaynor@email.chop.edu
authors: J William
authors: JW
authors: Gaynor
authors: Alex S
authors: AS
authors: Nord
authors: Gil
authors: G
authors: Wernovsky
authors: Judy
authors: J
authors: Bernbaum
authors: Cynthia B
authors: CB
authors: Solot
authors: Nancy
authors: N
authors: Burnham
authors: Elaine
authors: E
authors: Zackai
authors: Patrick J
authors: PJ
authors: Heagerty
authors: Robert R
authors: RR
authors: Clancy
authors: Susan C
authors: SC
authors: Nicolson
authors: Gail P
authors: GP
authors: Jarvik
authors: Marsha
authors: M
authors: Gerdes
mesh_terms: D001057:Apolipoproteins E / Q000235:genetics*; D001288:Attention / Q000502:physiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000235:genetics; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000235:genetics*; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007175:Impulsive Behavior / Q000235:genetics; D007398:Interpersonal Relations; D008297:Male; D011184:Postoperative Period; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D001057:Apolipoproteins E