School-Age Developmental and Educational Outcomes Following Cardiac Procedures in the First Year of Life: A Population-Based Record Linkage Study
The purpose of the study was to evaluate school-age developmental and educational outcomes for children with and without a cardiac procedure in the first year of life to improve understanding of longer-term neurodevelopmental outcomes in children who have had a cardiac procedure for congenital heart disease, the most common serious congenital anomaly. A population-based cohort study using record linkage of state-wide data was undertaken, evaluating children born in New South Wales, Australia, 2001–2007. Those with and without a cardiac procedure in the first year of life with a linked developmental (Australian version Early Development Instrument testing result, age 4–6 years) and/or educational outcome (Australian National Assessment Program result, age 7–9 years) were included. Perinatal, perioperative and sociodemographic factors were examined using multivariable logistic regression models. Of 468,329 eligible children, 768 had a cardiac procedure in the first year of life and 582 were included. For those with a cardiac procedure and developmental outcome (n = 260), 13.1% were classified as having ‘special needs’ compared to 4.4% without a cardiac procedure. Of those with an educational outcome, after adjusting for perinatal, perioperative and demographic variables, children with a cardiac procedure (n = 396) were twice as likely to score below National Minimum Standard in school literacy and numeracy tests compared to their peers. Significant predictors included low birthweight, parent not completing school and having > 4 re-hospitalisations in their first six years. The developmental and educational trajectory of children who have had a cardiac procedure in their first year remains altered into primary school years. While perioperative factors did not impact outcomes, ongoing health and sociodemographic factors were important in identifying those children at greatest risk.
KeywordsPaediatrics Congenital heart disease Cardiac surgery Developmental disabilities School-age population
We acknowledge and thank the NSW Ministry of Health, the Australian version of the Early Development Instrument and the NSW Department of Education for providing access to population health, development and education data, respectively, and the NSW Centre for Health Record Linkage for linking the data sets. The Australian version of the Early Development Instrument is funded by the Australian Government Department of Education and Training. The findings and views reported in this study are those of the authors and should not be attributed to these departments.
This project was supported by a HeartKids Grant-in-aid (2015). Dr Lain was supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (1054751) and Prof Nassar was supported by a NHMRC Career Development Fellowship (APP1067066). The funding sources were not involved in the study design, data collection, analysis, interpretation or decision to submit the manuscript for publication.
Compliance with Ethical Standards
Conflict of interest
Authors Lawley, Winlaw, Sholler, Badawi, Walker, Martin, Nassar and Lain declare they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval for this project to access, link and release data for research was obtained from the NSW Population and Health Services Research Ethics Committee and relevant data custodians (reference number 2012-12-430).
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