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Canadian Journal of Cardiology

Early Repair of Congenital Heart Disease Associated With Increased Rate of Attention Deficit Hyperactivity Disorder Symptoms

Published:October 14, 2013DOI:https://doi.org/10.1016/j.cjca.2013.07.007

      Abstract

      Background

      As more children survive with congenital heart disease, their neurodevelopmental outcomes (including attention deficit hyperactivity disorder [ADHD]) are becoming increasingly important. The objective of our study was to determine if school-aged children who underwent early cardiac surgery for congenital heart disease are more likely than healthy control subjects to have screening scores on the Swanson, Nolan, and Pelham IV (SNAP-IV) questionnaire suggestive of ADHD.

      Methods

      Children aged 7-15 years who underwent open-heart surgery before 1 year of age were identified from the Izaak Walton Killam (IWK) Children's Heart Centre Database. Control subjects were recruited from healthy volunteers. The SNAP-IV questionnaire was administered to all participants and a chart review was performed on all eligible children in the cardiac surgery group. Case and control subjects were compared using Fisher's exact test, linear, and logistic regression analyses. Potential predictors of a positive screening score were sought.

      Results

      A positive screening score was found in 29% (16/56) of the surgical group compared with 3% (2/60) of the control group (P < 0.001). Surgical and control subjects differed in average overall scores (0.93 vs 0.30; P < 0.001) and in scores for hyperactivity (0.83 vs 0.24; P < 0.001) and inattention (1.04 vs 0.37; P < 0.001). No other significant predictors of a positive screening score were identified. The early open-heart surgery participants who responded to the questionnaire did not differ in baseline characteristics compared with nonresponders.

      Conclusions

      Children who have open-heart surgery at younger than 1 year of age are more likely than healthy control subjects to have a SNAP-IV score suggestive of ADHD when they reach school age.

      Résumé

      Introduction

      Puisque plus d’enfants survivent à la cardiopathie congénitale, leurs issues neurodéveloppementales (incluant le trouble déficitaire de l’attention avec hyperactivité [TDAH]) sont devenues de plus en plus importantes. L’objectif de notre étude était de déterminer si les enfants d’âge scolaire qui avaient subi une chirurgie cardiaque précoce en raison d’une cardiopathie congénitale étaient plus susceptibles que les témoins en santé d’avoir des scores de dépistage au questionnaire SNAP-IV (Swanson, Nolan, and Pelham IV) évocateurs du TDAH.

      Méthodes

      Les enfants âgés de 7 à 15 ans qui avaient subi une chirurgie à cœur ouvert avant l’âge de 1 an provenaient de la base de données de l'Izaak Walton Killam (IWK) (IWK Children’s Heart Centre : Centre de soins de santé cardiaque pour les enfants IWK). Les témoins ont été recrutés parmi des volontaires en santé. Le questionnaire SNAP-IV a été effectué par tous les participants et une étude des dossiers de tous les enfants admissibles au groupe de chirurgie cardiaque a été réalisée. Les sujets malades et les témoins ont été comparés à l’aide du test exact de Fisher, et des analyses de régression linéaire et de régression logistique. Les prédicteurs potentiels d’un score de dépistage positif ont été recherchés.

      Résultats

      Un score de dépistage positif a été observé dans 29 % (16/56) du groupe de chirurgie comparativement à 3 % (2/60) du groupe témoin (P < 0,001). Les sujets du groupe de chirurgie et les témoins ont différé dans les scores moyens globaux (0,93 vs 0,30; P < 0,001) et dans les scores relatifs à l’hyperactivité (0,83 vs 0,24; P < 0,001) et à l’inattention (1,04 vs 0,37; P < 0,001). Aucun prédicteur significatif d’un score de dépistage positif n’a été déterminé. Les participants ayant eu une chirurgie à cœur ouvert précoce qui avaient répondu au questionnaire n’ont pas différé sur le plan des caractéristiques initiales comparativement aux non-répondants.

      Conclusions

      Les enfants qui ont une chirurgie à cœur ouvert avant l’âge de 1 an sont plus susceptibles que les témoins en santé d’avoir un score au SNAP-IV évocateur du TDAH lorsqu’ils atteignent l’âge scolaire.
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