title: Long-Term Neurodevelopmental Outcomes in Children and Adolescents With Congenital Heart Disease.
abstract: BACKGROUND
  Effective medical and surgical management of pediatric congenital heart disease (CHD) to reduce long-term adverse neurodevelopmental outcomes is an important clinical objective in primary and specialty health care. We identify clinical predictors associated with an increased risk of 6 long-term neurodevelopmental outcomes in children with CHD compared to the general pediatric Medicaid population.
  
  
  METHODS
  South Carolina's retrospective, 15-year Medicaid data set (January 1, 1996-December 31, 2010) for 19,947 patients aged ≤ 17 years diagnosed with ≥ 1 CHD lesions (on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes) were compared to 19,948 patients without CHD matched on age at entry into and duration in Medicaid using logistic and Cox proportional hazards regression.
  
  
  RESULTS
  The CHD cohort was significantly less likely to have incident neurologic or psychiatric disorders, mental retardation, developmental delays, or inattention/hyperactivity (adjusted odds ratios [ORs] = 0.34, 0.56, 0.03, 0.01, 0.004, respectively) but was more likely to have incident seizures (OR = 2.00) compared to controls. Exposure to both cardiac and noncardiac surgical intervention was associated with a significantly increased risk of developing neurologic or psychiatric disorders, mental retardation, developmental delays, or inattention/hyperactivity (cardiac ORs = 1.66, 2.00, 1.67, 1.43, 1.76, respectively) (noncardiac ORs = 2.25, 1.59, 1.48, 1.29, 1.36, 2.46, respectively). Any documented hypoxemia was associated with a significantly increased risk of developing 5 of the neurodevelopmental conditions (neurologic OR = 4.52, psychiatric OR = 1.60, mental retardation OR = 2.90, developmental delay OR = 2.12, seizures OR = 4.23).
  
  
  CONCLUSIONS
  Practitioners should maintain vigilant surveillance of all CHD patients, especially those exposed to surgical procedures or experiencing hypoxemia, to identify any neurodevelopmental issues early and address them promptly.
authors.affiliation: Departments of Neuropsychiatry and Behavioral Science and Pediatrics, University of South Carolina School of Medicine, Columbia.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Jerrell
authors.affiliation: Departments of Neuropsychiatry and Behavioral Science and Pediatrics, University of South Carolina School of Medicine, Columbia.
authors.forename: C Osborne
authors.initials: CO
authors.lastname: Shuler
authors.affiliation: Department of Medicine, Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Avnish
authors.initials: A
authors.lastname: Tripathi
authors.affiliation: Department of Internal Medicine, University of Virginia, Charlottesville.
authors.forename: George B
authors.initials: GB
authors.lastname: Black
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia.
authors.forename: Yong-Moon Mark
authors.initials: YM
authors.lastname: Park
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