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Academic Proficiency in Children After Early Congenital Heart Disease Surgery

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Abstract

Children with early surgery for congenital heart disease (CHD) are known to have impaired neurodevelopment; their performance on school-age achievement tests and their need for special education remains largely unexplored. The study aimed to determine predictors of academic achievement at school age and placement in special education services among early CHD surgery survivors. Children with CHD surgery at <1 year of age from January 1, 1998 to December 31, 2003, at the Arkansas Children’s Hospital were identified. Out-of-state births and infants with known genetic and/or neurologic conditions were excluded. Infants were matched to an Arkansas Department of Education database containing standardized assessments at early school age and special-education codes. Predictors for achieving proficiency in literacy and mathematics and the receipt of special education were determined. Two hundred fifty-six children who attended Arkansas public schools and who had surgery as infants were included; 77.7 % had either school-age achievement-test scores or special-education codes of mental retardation or multiple disabilities. Scores on achievement tests for these children were 7–13 % lower than those of Arkansas students (p < 0.01). They had an eightfold increase in receipt of special education due to multiple disabilities [odds ratio (OR) 10.66, 95 % confidence interval (CI) 4.23–22.35] or mental retardation (OR 4.96, 95 % CI 2.6–8.64). Surgery after the neonatal period was associated with decreased literacy proficiency, and cardiopulmonary bypass during the first surgery was associated with decreased mathematics proficiency. Children who had early CHD surgery were less proficient on standardized school assessments, and many received special education. This is concerning because achievement-test scores at school age are “real-world” predictors of long-term outcomes.

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Acknowledgments

This study was supported by the University of Arkansas for Medical Sciences Center for Translational Neuroscience award from The National Institutes of Health (P20 GM103425), the Arkansas Children’s Hospital Research Institute, and the Arkansas Biosciences Institute, which provided dedicated research time to S. B. Mulkey as well as statistical support by C. J. Swearingen and M. S. Melguizo. The authors appreciate Sadia Malik (Department of Pediatrics, University of Arkansas for Medical Sciences), who assisted with the large-group classification of infants [8], and Joseph Bates (Arkansas Department of Health) and Shalini Manjanatha (Arkansas Department of Health) for helping to ensure the quality and completeness of study data.

Conflict of interest

S. B. Mulkey receives funding from the University of Arkansas for Medical Sciences Center for Translational Neuroscience, the Arkansas Children’s Hospital Research Institute, and the Arkansas Biosciences Institute. The other authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Pediatrics, University of Arkansas for Medical Sciences, 1 Children’s Way, Slot 512-15, Little Rock, AR, 72202, USA

    Sarah B. Mulkey, Christopher J. Swearingen, Maria S. Melguizo & Adnan T. Bhutta

  2. Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sarah B. Mulkey & Jacob A. Rowell

  3. Arkansas Children’s Hospital Research Institute, Little Rock, AR, USA

    Rachel N. Reeves

  4. Arkansas Research Center, Arkansas Department of Education, Conway, AR, USA

    Neal Gibson & Greg Holland

  5. Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    Jeffrey R. Kaiser

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  1. Sarah B. Mulkey
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Correspondence to Sarah B. Mulkey.

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Mulkey, S.B., Swearingen, C.J., Melguizo, M.S. et al. Academic Proficiency in Children After Early Congenital Heart Disease Surgery. Pediatr Cardiol 35, 344–352 (2014). https://doi.org/10.1007/s00246-013-0781-6

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  • DOI: https://doi.org/10.1007/s00246-013-0781-6

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