Abstract
Children with congenital heart defects (CHDs) are at risk for poor academic performance. The degree to which receipt of health care services is associated with adverse academic outcomes is not known. We examined the association between episodes of cardiac care and third-grade performance in children with CHD. We identified subjects between 1/1/2008 and 4/30/2012 among 5 centers in North Carolina. We classified children by CHD type and linked subjects to the state educational records. Any inpatient or outpatient cardiac encounter on a date of service was considered an encounter. We calculated the number of encounters by adding the number of inpatient or outpatient cardiac visits prior to the date of the end-of-grade (EOG) tests. We estimated the odds of failing third-grade reading or math EOG tests by episodes of care stratified at the 50th percentile, controlling for CHD type, maternal education, sex, race/ethnicity, birth weight, and gestational age. A total of 184 children had third-grade EOG scores linked to health care records. The median number of episodes of care was 4 (range: 1–60). Those with visits ˃ 50th percentile (> 4 encounters/year over the 4.3 year observation period) had 2.09 (95% CI 1.04, 4.21) greater odds of failing the math EOG compared to those ≤ 50th percentile (1–4 encounters). The third-grade math score declined by 1.5 points (P < 0.008) for every 10 episodes of care. There was no association of episodes of care on third-grade reading performance. Children with CHD with > 4 episodes of cardiac care/year may be at risk for delays in third-grade academic performance. Strategies to minimize school absenteeism may improve academic success in this population.
Similar content being viewed by others
Abbreviations
- CHD:
-
Congenital heart defect
- EMR:
-
Electronic medical record
- NC:
-
North Carolina
- EOG:
-
End-of-grade
- NCBDMP:
-
North Carolina birth defects monitoring program
References
Gilboa SM, Devine OJ, Kucik JE, Oster ME, Riehle-Colarusso T, Nembhard WN, Xu P, Correa A, Jenkins K, Marelli AJ (2016) Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010. Circulation 134(2):101–109
Marino BS, Lipkin PH, Newburger JW, Peacock G, Gerdes M, Gaynor JW, Mussatto KA, Uzark K, Goldberg CS, Johnson WH Jr, Li J, Smith SE, Bellinger DC, Mahle WT, American Heart Association Congenital Heart Defects Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Stroke Council (2012) Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 126(9):1143–72
Gaudete I, Paquette N, Bernard C, Doussau A, Harvey J, Beaulieu-Genest L, Pinchefsky E, Trudeau N, Poirier N, Simard MN, Gallagher A, Clinique d’Investigation Neuro-Cardiaque (CINC) interdisciplinary team (2021) Neurodevelopmental outcome of children with congenital heart disease: a cohort study from infancy to preschool age. J Pediatr 239:126-135.e5
Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G (2008) Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics 121(4):e759-767
Morrissey TW, Hutchison L, Winsler A (2014) Family income, school attendance, and academic achievement in elementary school. Dev Psychol 50(3):741–753
https://www.aecf.org/resources/early-warning-why-reading-by-the-end-of-third-grade-matters. Accessed: July 14, 2022
Chen MY, Riehle-Colarusso T, Yeung LF, Smith C, Farr SL (2018) Children with heart conditions and their special health care needs—United States. MMWR Morb Mortal Wkly Rep 67(38):1045–1049
Islam S, Kaul P, Tran DT, Mackie AS (2018) Health care resource utilization among children with congenital heart disease: a population-based study. Can J Cardiol 34(10):1289–1297
Aucejo EM, Romano TF (2016) Assessing the effect of school days and absences on test score performance. Econ Educ Rev 55:70–87
Glinianaia SV, McLean A, Moffat M, Shenfine R, Armaroli A, Rankin J (2021) Academic achievement and needs of school-aged children born with selected congenital anomalies: a systematic review and meta-analysis. Birth Defects Res 113(20):1431–1462
Oster ME, Watkins S, Hill KD, Knight JH, Meyer RE (2017) Academic outcomes in children with congenital heart defects: a population-based cohort study. Circ Cardiovasc Qual Outcomes. https://doi.org/10.1161/CIRCOUTCOMES.116.003074
Riehle-Colarusso T, Autry A, Razzaghi H et al (2015) Congenital heart defects and receipt of special education services. Pediatrics 136(3):496–504
Mulkey SB, Swearingen CJ, Melguizo MS et al (2014) Academic proficiency in children after early congenital heart disease surgery. Pediatr Cardiol 35(2):344–352
Mulkey SB, Bai S, Luo C et al (2016) School-age test proficiency and special education after congenital heart disease surgery in infancy. J Pediatr 178(47–54):e41
Jill Glidewell M, Farr SL, Book WM, Botto L, Li JS, Soim AS, Downing KF, Riehle-Colarusso T, D’Ottavio AA, Feldkamp ML, Khanna AD, Raskind-Hood CL, Sommerhalter KM, Crume TL (2021) Individuals aged 1–64 years with documented congenital heart defects at health care encounters five, U.S. surveillance sites. 2011–2013. Am Heart J 238:100–108
von Rhein M, Buchmann A, Hagmann C, Huber R, Klaver P, Knirsch W, Latal B (2014) Brain volumes predict neurodevelopment in adolescents after surgery for congenital heart disease. Brain 137(Pt 1):268–276
Glinianaia SV, McLean A, Moffat M, Shenfine R, Armaroli A, Rankin J (2021) Academic achievement and needs of school-aged children born with selected congenital anomalies: a systematic review and meta-analysis. Birth Defects Res 113(20):1431–1462. https://doi.org/10.1002/bdr2.1961
Wotherspoon JM, Eagleson KJ, Gilmore L, Auld B, Hirst A, Johnson S, Stocker C, Heussler H, Justo RN (2020) Neurodevelopmental and health-related quality-of-life outcomes in adolescence after surgery for congenital heart disease in infancy. Dev Med Child Neurol 62(2):214–220. https://doi.org/10.1111/dmcn.14251
Bean Jaworski JL, White MT, DeMaso DR, Newburger JW, Bellinger DC, Cassidy AR (2018) Visuospatial processing in adolescents with critical congenital heart disease: organization, integration, and implications for academic achievement. Child Neuropsychol 24(4):451–468. https://doi.org/10.1080/09297049.2017.1283396
Mammarella IC, Caviola S, Giofrè D, Szűcs D (2018) The underlying structure of visuospatial working memory in children with mathematical learning disability. Br J Dev Psychol 36(2):220–235
Funding
This study was funded by a cooperative agreement with the Centers for Disease Control and Prevention: 1NU50DD000054-01-00.
Author information
Authors and Affiliations
Contributions
SW and JL wrote the main manuscript text. TH, RH, CS, LS, JP, KW, MW, NF, and JL obtained data. AD performed database management. SW performed statistical analysis and prepared the tables and figure. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
Stephanie Watkins: Employee of Gilead Sciences. The remaining authors have no disclosures.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Watkins, S., Kemper, A.R., D’Ottavio, A. et al. Third-Grade Academic Performance and Episodes of Cardiac Care Among Children with Congenital Heart Defects. Pediatr Cardiol 44, 472–478 (2023). https://doi.org/10.1007/s00246-022-03066-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-022-03066-w