title: Association Between Method of Cerebral Protection During Neonatal Aortic Arch Surgery and Attention Deficit/Hyperactivity Disorder.
abstract: BACKGROUND
  Neonates undergoing repair of the aortic arch are at risk for adverse neurodevelopmental outcomes, including attention deficit/hyperactivity disorder (ADHD). The purpose of this study was to compare the effect of deep hypothermic circulatory arrest versus regional cerebral perfusion on the long-term outcome of ADHD.
  
  
  METHODS
  This study is a cross-sectional observational study of ADHD in children who underwent neonatal aortic arch surgery. Attention Deficit/Hyperactivity Disorder-IV surveys were used to determine the prevalence of ADHD. Review of the medical records was performed to determine the primary method of cerebral protection and to extract related surgical variables.
  
  
  RESULTS
  Surveys were sent to parents of 134 children, with 57 surveys completed (43%). The percentage of children classified as having ADHD was 44%. Children with a diagnosis of interrupted aortic arch had the highest prevalence of ADHD (85%). Multivariate analysis demonstrated that interrupted aortic arch was associated with an increased ADHD inattention score (p < 0.01), and a decreased Child Health Questionnaire-50 psychosocial score (p < 0.01). Low Child Health Questionnaire-50 psychosocial summary scores are associated with increased behavioral problems and are lower in patients with ADHD.
  
  
  CONCLUSIONS
  Attention deficit/hyperactivity disorder is common after neonatal aortic arch surgery and may be primarily related to genetic predisposition. We found insufficient evidence to show that either deep hypothermic circulatory arrest or regional cerebral perfusion decreased the risk of ADHD.
authors.affiliation: College of Health Professions, Medical University of South Carolina, Charleston, South Carolina. Electronic address: sistinoj@musc.edu.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Sistino
authors.affiliation: Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.affiliation: College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Charles
authors.initials: C
authors.lastname: Ellis
authors.affiliation: College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: John S
authors.initials: JS
authors.lastname: Ikonomidis
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D001013:Aorta, Thoracic / Q000601:surgery*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003430:Cross-Sectional Studies; D006801:Humans; D007231:Infant, Newborn; D015999:Multivariate Analysis; D010477:Perfusion; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires