Skip to main content Accessibility help
×
Home
Hostname: page-component-568f69f84b-l2zqg Total loading time: 1.036 Render date: 2021-09-17T06:18:33.022Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

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*
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
*Corresponding
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

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.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

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

References

1. DeMaso, DR. Pediatric heart disease. In: Brown RT (ed). Handbook of Pediatric Psychology in School Settings. Lawrence Erlbaum Associates, Inc, Hillsdale, NJ, 2004, pp 283298.Google Scholar
2. Horner, T, Liberthson, R, Jellinek, MS. Psychosocial profile of adults with complex congenital heart disease. Mayo Clin Proc 2000; 75: 3136.CrossRefGoogle ScholarPubMed
3. Brandhagen, DJ, Feldt, RH, Williams, DE. Long-term psychologic implications of congenital heart disease: A 25-year follow-up. Mayo Clin Proc 1991; 66: 474479.CrossRefGoogle ScholarPubMed
4. Wright, M, Nolan, T. Impact of cyanotic heart disease on school performance. Arch Disease Child 1994; 71: 6470.CrossRefGoogle ScholarPubMed
5. Oates, RK, Turnbull, JAB, Simpson, JM, et al. Parent and teacher perceptions of child behaviour following cardiac surgery. Acta Paediatr 1994; 83: 13031304.CrossRefGoogle ScholarPubMed
6. Bjornstad, PG, Spurklund, I, Lindberg, HL. The impact of severe congenital heart disease on physical and psychosocial functioning in adolescents. Cardiol Young 1995; 5: 5662.CrossRefGoogle Scholar
7. Gupta, S, Giuffre, RM, Crawford, S, et al. Covert fears, anxiety and depression in congenital heart disease. Cardiol Young 1998; 8: 491499.CrossRefGoogle ScholarPubMed
8. Ellerbeck, KA, Smith, ML, Holden, EW, et al. Neurodevelopmental outcomes in children surviving d-transposition of the great arteries. J Dev Behav Pediatr 1998; 19: 335341.CrossRefGoogle ScholarPubMed
9. Spijkerboer, AW, Utens, EM, Bogers, AJ, Verhulst, FC, Helbing, WA. Long-term behavioural and emotional problems in four cardiac diagnostic groups of children and adolescents after invasive treatment for congenital heart disease. Int J Cardiol 2008; 28: 6673.CrossRefGoogle Scholar
10. Miatton, M, De Wolf, D, Francois, K, Thiery, E, Vingerhoets, G. Intellectual, neuropsychological, and behavioral functioning in children with Tetraology of Fallot. J Thorac Cardiovasc Surg 2007; 133: 449455.CrossRefGoogle Scholar
11. Miatton, M, De Wolf, D, Francois, K, Thiery, E, Vingerhoets, G. Behavior and self-perception in children with a surgically corrected congenital heart disease. J Dev Behav Pediatr 2007; 28: 294301.CrossRefGoogle ScholarPubMed
12. Kong, SG, Tay, JSH, Yip, WCL, et al. Emotional and social effects of congenital heart disease in Singapore. Austral Paediatr J 1986; 22: 101106.Google ScholarPubMed
13. Uzark, K, Jones, K. Parenting stress and children with heart disease. J Pediatr Health Care 2003; 17: 163168.CrossRefGoogle ScholarPubMed
14. DeMaso, DR, Campis, LK, Wypij, D, et al. The impact of maternal perceptions and medical severity on the adjustment of children with congenital heart disease. J Pediatr Psychol 1991; 16: 137149.CrossRefGoogle ScholarPubMed
15. Casey, FA, Sykes, DH, Craig, BG, et al. Behavioral adjustment of children with surgically palliated complex congenital heart disease. J Pediatr Psychol 1996; 21: 335352.CrossRefGoogle ScholarPubMed
16. McCusker, CG, Doherty, NN, Molloy, B, et al. Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease. Arch Dis Child 2007; 92: 137141.CrossRefGoogle ScholarPubMed
17. Spurkland, I, Bjornstad, PG, Lindberg, H, et al. Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect. Acta Paediatr 1993; 82: 7176.CrossRefGoogle ScholarPubMed
18. Utens, EM, Verhulst, FC, Duivenvoorden, HJ, et al. Prediction of behavioural and emotional problems in children and adolescents with operated congenital heart disease. Europ Heart J 1998; 19: 801807.CrossRefGoogle ScholarPubMed
19. Utens, EM, Verhulst, FC, Meijboom, FJ, et al. Behavioural and emotional problems in children and adolescents with congenital heart disease. Psycholog Med 1993; 23: 415424.CrossRefGoogle ScholarPubMed
20. DeMaso, DR, Beardslee, WR, Silbert, AR, et al. Psychological functioning in children with cyanotic heart defects. J Dev Behav Pediatr 1990; 11: 289294.CrossRefGoogle ScholarPubMed
21. Dunbar-Masterson, C, Wypij, D, Bellinger, DC, et al. General health status of children with D-transposition of the great arteries after the arterial switch operation. Circulation 2001; 104 (Suppl I): I138I142.CrossRefGoogle ScholarPubMed
22. Newburger, JW, Jonas, RA, Wernovsky, G, et al. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 1993; 329: 10571064.CrossRefGoogle ScholarPubMed
23. Bellinger, DC, Jonas, RA, Rappaport, LA, et al. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 1995; 332: 549555.CrossRefGoogle ScholarPubMed
24. Bellinger, DC, Wypij, D, Kuban, KCK, et al. Developmental and neurological status at four years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 1999; 100: 526532.CrossRefGoogle ScholarPubMed
25. Bellinger, DC, Wypij, D, duPlessis, AJ, et al. Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 13851396.CrossRefGoogle ScholarPubMed
26. Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: A comparison of low-flow cardiopulmonary bypass versus circulatory arrest. Circulation 1995; 92: 22262235.CrossRefGoogle Scholar
27. Newburger, JW, Wypij, D. Methods and procedures. In: Jonas RA, Newburger JW, Volpe JJ (eds). Brain Injury and Pediatric Cardiac Surgery. Butterworth-Heinemann, Boston, MA, 1996, pp 289310.Google Scholar
28. Achenbach, TM. Manual for the Child Behavior Checklist/4-18 and 1991 Profile. University of Vermont, Burlington, VT, 1991.Google Scholar
29. Connors, CK. Connors’ Rating Scales Manual. Multi-Health Systems, Inc., North Tonawanda, NY, 1990.Google Scholar
30. Achenbach, TM. Manual for the Teacher’s Report Form and 1991 Profile. University of Vermont, Burlington, VT, 1991.Google Scholar
31. Helmers, SL, Wypij, D, Constantinou, JE, et al. Perioperative electroencephalographic seizures in infants undergoing repair of complex congenital cardiac defects. Electroenceph Clin Neurophysiol 1997; 102: 2736.CrossRefGoogle ScholarPubMed
32. Wechsler, D. Wechsler Preschool and Primary Scale of Intelligence-Revised. The Psychological Corporation, San Antonio, 1989.Google Scholar
33. Wechsler, D. Wechsler Intelligence Scale for Children-Third Edition. The Psychological Corporation, San Antonio, 1991.Google Scholar
34. Abidin, R. Parenting Stress Index- Manual. Pediatric Psychology Press, Charlottesville, VA, 1995.Google Scholar
35. Holmes, T, Rahe, R. The Social Readjustment Rating Scale. J Psychosom Res 1967; 11: 213218.CrossRefGoogle ScholarPubMed
36. Olson, D, Portner, J. Family Adaptability and Cohesion Evaluation Scales. In: Filsinger E (ed). Marriage and Family Assessment. Sage Publications, Beverly Hills, 1983, p 299.Google Scholar
37. Hofstra, MB, Van der Ende, J, Verhulst, FC. Continuity and change of psychopathology from childhood into adulthood: A 14-year follow-up study. J Am Acad Child Adol Psychiatr 2000; 39: 850858.CrossRefGoogle ScholarPubMed
38. Mattison, RE, Spitznagel, EL. Long-term stability of Child Behavior Checklist profile types in a child psychiatric clinic population. J Am Acad Child Adol Psychiatr 1999; 38: 700707.CrossRefGoogle Scholar
39. Verhulst, FC, Koot, HM, Van der Ende, J. Differential predictive value of parents’ and teachers’ reports of children’s problem behaviors: A longitudinal study. J Abnorm Child Psychol 1994; 22: 531546.CrossRefGoogle ScholarPubMed
40. Stanger, C, Achenbach, TM, McConaughy, SH. Three-year course of behavioral/emotional problems in a national sample of 4- to 16-year-olds: III. Predictors of signs of disturbance. J Consult Clin Psychol 1993; 61: 839848.CrossRefGoogle Scholar
95
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *