Outcomes In School-aged Children Research Articles

The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial

Suboptimum adherence to preventive asthma treatment is associated with substantial morbidity and mortality, yet adherence often remains poor. We aimed to investigate whether use of an inhaler with audiovisual reminders leads to improved adherence and asthma outcomes in school-aged children who presented to the emergency department with an asthma exacerbation. We did a randomised controlled trial in patients aged 6-15 years who attended the regional emergency department in Auckland, New Zealand with an asthma exacerbation and were on regular inhaled corticosteroids. Using a simple, unrestricted block randomisation with block sizes of 200, we randomly assigned patients to receive an electronic monitoring device for use with their preventer inhaler with the audiovisual reminder functions either enabled to support adherence to inhaled corticosteroids (intervention group) or disabled (control group). Participants were followed up every 2 months for 6 months. The primary outcomes were adherence to preventive inhaled corticosteroids and number of days absent from school for any reason. Asthma control was assessed as a secondary outcome. All analyses were done in the intention-to-treat population. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001353785. The study took place between May 10, 2010, and Feb 26, 2012. We randomly assigned 220 patients, 110 to the intervention group and 110 to the control group. Median percentage adherence was 84% (10th percentile 54%, 90th percentile 96%) in the intervention group, compared with 30% (8%, 68%) in the control group (p<0·0001). The proportion of days absent from school for any reason was 1·9% (10th percentile 0·0%, 90th percentile 7·9%) in the intervention group and 1·7% (0·0%, 8·6%) in the control group. The change in asthma morbidity score from baseline to 6 months was significantly greater in the intervention group than in the control group (p=0·008), with a reduction of 2·0 points from a mean baseline score of 9·3 (SD 2·2) to 7·3 (2·1) in the intervention group, compared with a reduction of 1·2 points from a baseline of 9·2 (2·5) to 8·0 (2·2) in the control group. Use of an electronic monitoring device with an audiovisual reminder led to significant improvements in adherence to inhaled corticosteroids in school-aged children with asthma. This intervention could be beneficial for the improvement of asthma control in patients for whom poor asthma control is related to poor adherence. Health Research Council of New Zealand and Cure Kids.

Duration of post-traumatic amnesia as a predictor of functional outcome in school-age children: a systematic review.

In adults, duration of post-traumatic amnesia (PTA) is a powerful early predictor of functional outcomes in traumatic brain injury. The aim of this work was to assess the predictive validity of PTA duration for outcomes in children (6-18y). PsycINFO, MEDLINE, Web of Science, and Embase were searched for papers published to January 2014. Ten studies met inclusion criteria: they used standardized instruments to assess PTA and functional outcomes, and examined relationships between the two. Outcomes were classified according to (1) the International Classification of Functioning, Disability and Health (ICF) core sets for neurological conditions for post-acute care and (2)global functioning and quality of life. Methodological quality was rated for each study. The search identified 10 studies of moderate mean quality (M=11.8 out of 18). Longer PTA duration related to worse functional outcomes: global functioning and in the two ICF categories ('body function', 'activities and participation'). Relationships between PTA duration and quality of life and the ICF category of 'body structure' were not examined. PTA duration was, in 46 out of 60 (76.67%) instances, a stronger predictor of outcomes than other indices of injury severity. Longer PTA duration is a valid predictor of worse outcomes in school-age children. Thus, PTA should be routinely assessed in children after traumatic brain injury.

Antenatal Magnesium Sulfate and Outcomes for School-aged Children

Antenatal Magnesium Sulfate and Outcomes for School-aged Children

Increased service integration paves the way for better mental health outcomes for school aged children and young people in schools

Introduction: In February 2014, ConNetica was contracted by Queensland Mental Health Commission (QMHC) to undertake an evaluation of the Queensland Ed-LinQ Initiative. The EdLinQ Initiative is a statewide initiative that is funded through the Queensland Plan for Mental Health (2007-2017) and administered by Queensland Health. Ed-LinQ works strategically at a state and district level to improve linkages between the education sector, the primary care sector and the mental health sector. The program aims to support these sectors to work collaboratively to enhance the early detection and treatment of mental illness affecting school-aged children and young people. Approach: The evaluation took an iterative and formative approach to enable the project evaluation team to consult with the QMHC Project Manager and the Evaluation Working Group (EWG) to reflect on the findings as the project developed and take appropriate agreed actions to adjust or ‘pivot’ if necessary. Data was collected throughout the project from the Ed-LinQ Coordinators, Child and Youth Mental Health Service (CYMHS) staff, the Evaluation Working Group members, school personnel, national and international thought leaders in child and youth mental health, and other stakeholders via face-to-face interviews, phone interviews, focus groups and on line surveys. A total of 339 individuals have contributed to the data in this report. Target Audience: The Ed-LinQ program seeks to improve mental health outcomes for school aged children and young people. Program Overview: The range of services provided by the Ed-LinQ team relate to strengthening relationships between schools, CYMHS and other relevant services, building cross sector workforce capability in the area of mental health, streamlining referral processes between schools and CYMHS, supporting schools with their management of student mental health issues and communicating and or providing a range of mental health resources. Program Findings: The findings from the qualitative and quantitative research are complimentary and highlight the positive and highly valued impact of the Ed-LinQ initiative for a significant number of schools across Queensland. The impact has been greatest in areas where schools have ‘brought-in’ to the Ed-LinQ Initiative recognising the need to partner with Child and Youth Mental Health Services (CYMHS) rather than ‘off-load’ mental health issues to CYMHS or have limited engagement. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116690– http://www.ijic.org/ The findings showed that the Ed-LinQ Initiative has gone a long way to realising the stated objectives of forming strategic partnerships, building capacity, and providing clinical guidance. Schools where Ed-LinQ has had a high impact have reported improved referral pathways and access to specialist support, cross agency communication, enhanced workforce capability, more comprehensive school mental health promotion and prevention, better selection and use of available resources and a greater capacity to address the mental health needs of students. There is some evidence to suggest that Ed-LinQ has enhanced young people’s mental health, teachers’ well being and that it has had a culture change effect on CYMHS. Conclusion: This presentation will detail the range of key performance criteria that underpin improved integration between education and health providers to enable improved mental health services to school aged children and young people.

General and abdominal fat outcomes in school-age children associated with infant breastfeeding patterns

Breastfeeding may have a protective effect on the development of obesity in later life. Not much is known about the effects of infant feeding on more-specific fat measures. We examined associations of breastfeeding duration and exclusiveness and age at the introduction of solid foods with general and abdominal fat outcomes in children. We performed a population-based, prospective cohort study in 5063 children. Information about infant feeding was obtained by using questionnaires. At the median age of 6.0 y (95% range: 5.7 y, 6.8 y), we measured childhood anthropometric measures, total fat mass and the android:gynoid fat ratio by using dual-energy X-ray absorptiometry, and preperitoneal abdominal fat by using ultrasound. We observed that, in the models adjusted for child age, sex, and height only, a shorter breastfeeding duration, nonexclusive breastfeeding, and younger age at the introduction of solid foods were associated with higher childhood general and abdominal fat measures (P-trend < 0.05) but not with higher childhood body mass index. The introduction of solid foods at a younger age but not breastfeeding duration or exclusivity was associated with higher risk of overweight or obesity (OR: 2.05; 95% CI: 1.41, 2.90). After adjustment for family-based sociodemographic, maternal lifestyle, and childhood factors, the introduction of solid food between 4 and 4.9 mo of age was associated with higher risks of overweight or obesity, but the overall trend was not significant. Associations of infant breastfeeding and age at the introduction of solid foods with general and abdominal fat outcomes are explained by sociodemographic and lifestyle-related factors. Whether infant dietary composition affects specific fat outcomes at older ages should be further studied.

Childhood kidney outcomes in relation to fetal blood flow and kidney size.

Impaired fetal abdominal blood flow may lead to smaller kidneys and subsequent impaired kidney function in later life. In a prospective cohort study among 923 pregnant women and their children, we measured fetal growth, kidney volumes, and umbilical and cerebral artery blood flow (median gestational age of 30.3 weeks; 95% range, 28.5-32.7 weeks). We used a higher umbilical/cerebral artery pulsatility index ratio as an indicator of preferential fetal blood flow to the upper body parts at the expense of the intra-abdominal organs. At a median age of 5.9 years (95% range, 5.7-6.6 years), we measured childhood kidney volumes, creatinine and cystatin C blood levels, microalbuminuria, BP, and eGFR. A preferential fetal blood flow to the upper body parts at the expense of the intra-abdominal organs associated only with a smaller combined kidney volume in childhood. Fetal combined kidney volume positively associated with childhood combined kidney volume and eGFR, and inversely associated with childhood creatinine and cystatin C levels (all P values <0.05), but did not associate with childhood microalbuminuria and BP. Children within the highest tertile of fetal umbilical/cerebral ratio and the lowest tertile of fetal combined kidney volume had the lowest eGFR (difference, -6.36 ml/min per 1.73 m(2); 95% confidence interval, -11.78 to -0.94 compared with children within the middle tertiles). These data suggest that impaired fetal blood to the abdominal organs and smaller fetal kidney size are associated with subclinical changes in kidney outcomes in school-aged children.

Infant diet and metabolic outcomes in school-age children. The Generation R Study.

Breastfeeding duration is associated with the risks of cardio-metabolic diseases in adulthood. We examined the associations of infant feeding patterns with metabolic outcomes in children and whether any association was explained by family-based socio-demographic, maternal lifestyle-related or childhood factors. We performed a population-based prospective cohort study in 3417 children to examine the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with blood levels of lipids, insulin and C-peptide and risk of clustering of cardio-metabolic risk factors at the median age of 6.0 years (90% range 5.7-6.8). We observed that, in the models only adjusted for child's age and sex, ever breastfeeding was not associated with childhood blood levels of lipids but was associated with higher insulin and C-peptide concentrations (P-value<0.05). Breastfeeding duration and exclusivity were not consistently associated with metabolic outcomes. Early introduction of solid foods was associated with higher levels of total cholesterol (P-value<0.05) but not with high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides and insulin levels. Shorter breastfeeding duration and exclusive breastfeeding were associated with increased risks of clustering of cardio-metabolic risk factors. After additional adjustment for family, maternal and childhood factors, none of these associations remained significant. In conclusion, we found no consistent associations of infant feeding patterns with metabolic outcomes at school age, after taking into account family-based socio-demographic, maternal lifestyle-related or childhood factors. Whether infant diet composition influences metabolic outcomes in later life should be further studied.

Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea

The relationship between obstructive sleep apnoea (OSA) and poorer neurobehavioural outcomes in school-age children is well established, but the relationship in obese children and adolescents, in whom OSA is more common, is not so well established. We aimed to investigate this relationship in 10-18-year-olds. Thirty-one participants with a mean body mass index (BMI) of 32.3 ± 4.9 enrolled. BMI-for-age cut-offs were used to define obesity. Participants underwent polysomnography and were classified into OSA (apnoea-hypopnoea index (AHI) > 2 per hour) and non-OSA (AHI ≤ 2) groups. Intelligence, memory and learning, academic achievement, behaviour and executive functioning were assessed using the Wechsler Abbreviated Scale of Intelligence, Wide Range Assessment of Memory and Learning 2, Wechsler Individual Achievement Test II (WIAT-II), Behavioural Assessment System for Children 2 and Behaviour Rating Inventory of Executive Function, respectively. Forty-eight per cent (15/31) were classified as having OSA, and 52% (16/31) as non-OSA. The obese cohort performed below the average of normative data on several neurobehavioural measures. WIAT-II maths scores were significantly lower (P = 0.034) in the OSA group than in the non-OSA group (means 84.5 vs. 94.6, respectively), losing significance after adjustment for IQ, age and gender. Self-reported school problems were significantly worse in the OSA group before and after multivariate adjustment (P = 0.010, Cohen's d = 1.02). No other significant differences were found. Results suggest that OSA may increase risk for some poorer educational and behavioural outcomes. The findings are reasonably consistent with and add to the evidence base of the few studies that have explored this relationship.

Behavioural and emotional outcomes in school-aged children after surgery or transcatheter closure treatment for ventricular septal defect

We aimed to assess and compare the behavioural and emotional outcomes of school-aged children after surgery or transcatheter closure for ventricular septal defect and investigate the risk factors for developing abnormal behavioural problems with the condition. In this study, we included 29 children, including 20 boys, with ventricular septal defect who underwent surgery and 35 children, including 21 boys, who underwent transcatheter closure (6-13 years old) and their age- and sex-matched best friends (n = 56) and their parents. The Child Behavior Checklist was used to obtain standardised parents' reports of behavioural and emotional problems in children. The 28-item version of the General Health Questionnaire was used to assess parents' psychological distress. Pearson correlation and logistic regression were used to analyse risk factors for developing behaviour problems. Behavioural problems were greater for boys and girls undergoing surgery or transcatheter closure than controls. The behavioural problems were mainly depression, somatic complaints, and social withdrawal for boys and thought problems, depression, somatic complaints, and social withdrawal for girls. Depression and somatic complaints were greater for boys undergoing surgery than for boys undergoing transcatheter closure. Behavioural problems did not differ between treatment groups for girls. Risk factors for developing behavioural problems were age at the time of ventricular septal defect repair (p = 0.03; odds ratio = 2.35), skin scar (p = 0.04; odds ratio = 3.12), post-operative atrioventricular block (p = 0.03; odds ratio = 2.81), and maternal anxiety (p < 0.01; odds ratio = 4.5). School-aged children who underwent repair of ventricular septal defect regardless of the type of treatment (surgery or transcatheter closure) exhibit internalising behavioural problems. Risk factors for developing problems are young age, scarring, post-operative atrioventricular block, and maternal anxiety. In particular, maternal anxiety is the most important risk factor.

Reading Comprehension and Factors Affecting the Reading Outcomes in School-Aged Children with Cochlear Implants

Reading Comprehension and Factors Affecting the Reading Outcomes in School-Aged Children with Cochlear Implants

Reading performance is negatively impacted by high prenatal nicotine exposure

In this issue of The Journal, Cho et al from Yale University School of Medicine, investigate whether prenatal exposure to nicotine has an impact on reading skills in school-aged children. The authors studied over 5000 school-aged children from the Avon Longitudinal Study of Parents and Children in the United Kingdom. The results show that prenatal nicotine exposure was associated with increased risk of reduced reading skills. These effects were quite large and statistical modeling showed that environmental factors significantly affected the interaction between prenatal nicotine exposure and reading skill outcomes.Article page 713▶ In this issue of The Journal, Cho et al from Yale University School of Medicine, investigate whether prenatal exposure to nicotine has an impact on reading skills in school-aged children. The authors studied over 5000 school-aged children from the Avon Longitudinal Study of Parents and Children in the United Kingdom. The results show that prenatal nicotine exposure was associated with increased risk of reduced reading skills. These effects were quite large and statistical modeling showed that environmental factors significantly affected the interaction between prenatal nicotine exposure and reading skill outcomes. Article page 713▶ Prenatal Exposure to Nicotine and Impaired Reading PerformanceThe Journal of PediatricsVol. 162Issue 4PreviewTo investigate whether prenatal exposure to nicotine has an impact on several reading skill outcomes in school age children. Full-Text PDF

Cryptic residual GALT activity is a potential modifier of scholastic outcome in school age children with classic galactosemia

Classic galactosemia is a potentially lethal disorder that results from profound deficiency of galactose-1-phosphate uridylyltransferase (GALT), the second enzyme in the Leloir pathway of galactose metabolism. Although early diagnosis and rigorous dietary restriction of galactose prevent or resolve the potentially lethal acute symptoms, patients are at markedly increased risk of long-term complications including significant cognitive, speech, and behavioral difficulties, among other problems. The mechanisms that underlie these long-term complications remain unclear, as do the factors that modify their severity. Here we explored the scholastic and behavioral outcomes experienced by a cohort of 54 school age children with classic galactosemia. Data collected included survey responses from parents and teachers, school records including standardized test scores, and GALT genotype data used to estimate predicted residual GALT activity based on a yeast expression system. As expected, many but not all of the children in our study demonstrated speech, scholastic, and behavioral difficulties. Perhaps most striking, we found that predicted cryptic residual GALT activity, often below the threshold of detection of clinical assays, appeared to modify scholastic outcome. These data raise the intriguing possibility that cryptic GALT activity might also influence the severity of other long-term complications in classic galactosemia.

School-age spirometry in survivors of chronic lung disease of prematurity in the surfactant era

To assess whether school-age spirometry and lung volume outcomes of preterm infants with history of moderate to severe respiratory distress syndrome (RDS), born in the surfactant era and treated with conventional mechanical ventilation (IMV) and discharged home with or without the diagnosis of BPD (chronic lung disease of prematurity), differ from those of term neonates (controls). The study included 148 Caucasian school-aged children (38 preterm infants without BPD, 20 preterm infants with BPD and 90 term infants). All infants were born at the Department of Pathology of Pregnancy and Labor, Pomeranian Medical University Szczecin, Poland. Respiratory outcome in school-aged children was assessed using spirometry with the evaluation of flow and volume parameters, adjusted for age, weight and gender. The differences in spirometry were tested by the Wilcoxon or Mann-Whitney tests. Linear correlation and regression were also used. No statistically significant differences between the spirometric parameters in preterm infants with and without BPD were found. All investigated parameters were significantly lower in both ventilated groups compared to term controls, with the exception of ERV%, which was significantly higher The necessity to use assisted ventilation in preterm infants without neurological disorders most probably had an adverse effect on the lung function, assessed by spirometry at the age of 9-10 years, in the groups of children discharged home with or without BPD. Regardless of BPD, lung function parameters in prematurely born children with respiratory distress syndrome are always worse than in term controls.

Risk factors for neurodevelopmental impairments in school-age children after cardiac surgery with full-flow cardiopulmonary bypass

To determine the risk factors for adverse neurodevelopmental outcomes in school-age children after full flow open-heart surgery for congenital heart disease. The outcome was assessed in 117 children without a genetic comorbidity at a mean age of 10.4 ± 2.5 years. Intelligence was assessed using the Raven's Progressive Matrices and neuromotor function using the Zurich Neuromotor Assessment. Risk factors were retrieved from detailed chart review. The mean intelligence score was 89 ± 16, significantly lower than the norm (P < .001). Cerebral palsy was diagnosed in 10% of patients. Poor neuromotor performance (less than p10) was present in 15% to 20% of the children, depending on the motor task (all P < .001). Pure motor and static balance performance was also significantly impaired when patients with cerebral palsy were excluded (P < .01). Intelligence was only related to socioeconomic status (P = .006), and neuromotor outcome was related to the length of hospital stay and postoperative neurologic abnormalities (P < .03). The extracorporeal circulation time was related to adaptive fine motor performance (P = .05). All other variables were not related to outcome. Children without a genetic comorbidity are at risk of long-term intellectual and motor impairments also after full-flow cardiac repair. Surgery-related parameters play a less important role for adverse outcomes than postoperative complications. Our findings stress the importance of specialized follow-up assessments for all children with CHD undergoing open heart surgery.

Fathers' involvement and preschool children's behavior in stable single-mother families

Abstract The research testing bidirectional relationships between non-resident fathers' involvement and children's behavior usually models outcomes in school age children. It also tends to include both families in which fathers have never lived with their children and families in which fathers have resided with their children at least some of the time. In this study we used data from the first two sweeps of the Millennium Cohort Study (MCS) to model bidirectional links between non-resident fathers' involvement and the behavior of preschool children growing up in continuously single-mother families (N = 930). Children's behavior was measured with the Carey Infant Temperament Scale at Sweep 1 (age 9 months), and the Strengths and Difficulties Questionnaire at Sweep 2 (age 3 years). Non-resident father involvement was mother-reported. We found no evidence for father involvement effects on later child behavior, but strong evidence for the association between early and later non-resident father involvement.

Impaired Neuromotor Outcome in School-Age Children With Congenital Hypothyroidism Receiving Early High-Dose Substitution Treatment

Congenital hypothyroidism (CH) can lead to intellectual deficits despite early high-dose treatment. Our study aimed to determine whether motor impairments can occur despite early high-dose treatment. Sixty-three children with CH and early (median age of onset of treatment 9 d), high-dose treatment (median starting dose of levothyroxine 14.7 μg/kg/d) were tested with the Zurich Neuromotor Assessment (ZNA) at a median age of 13.8 y (range 7.0-14.2 y). Median z-scores in the children with CH were -0.95 in the pure and -0.56 in the adaptive fine motor component, significantly lower than in the ZNA test norms (p < 0.001 and p = 0.01, respectively). The 26 children with athyreosis were more affected than the 33 children with dysgenesis, particularly in the pure motor (-1.55 versus -0.76, p = 0.03), adaptive fine motor (-1.31 versus 0.13, p < 0.01), and static balance task (-0.47 versus 0.67, p = 0.01). Boys performed worse than girls. Older age at onset of treatment was related to poorer adaptive fine motor performance. Movement quality (assessed by associated movements) was not affected. We conclude that severe CH can cause neuromotor deficits persisting into adolescence. These deficits cannot completely be reversed by postnatal treatment, but earlier age at treatment may reduce the degree of impairment.

Maternal smoking cessation and reduced academic and behavioral problems in offspring

BackgroundThere is some debate whether smoking during pregnancy causes or is only a risk factor for negative academic outcomes and increased risk of psychopathology in offspring. This study evaluated whether maternal smoking cessation would reduce the risk of adverse outcomes in school-aged children. MethodsWomen completed an online survey that included items about child scholastic performance and the Child Behavior Checklist (CBCL). Mothers were divided based on pre-pregnancy and pregnancy smoking status into: (1) Nonsmokers (N=320); (2) Women that smoked in the 3 months preceding and throughout pregnancy (Smokers, N=83); and (3) Smoking before, but not during pregnancy (Quitters, N=72). ResultsThe Smokers and Quitters groups each had lower education and incomes compared to Nonsmokers but were indistinguishable from each other on these measures. The offspring of Smokers were more likely (p<.05) to be behind their peers on standardized tests in math (27.8%) relative to both Nonsmokers (17.4%) and Quitters (13.0%) with similar findings for reading. Smokers reported more behavioral problems by their children in several areas including Hyperactivity and Impulsivity, Social problems, and Externalizing problems including Aggression and Rule-Breaking. Further, the children of Quitters had significantly fewer Attention and Externalizing problems than Smokers. These outcomes were observed even after accounting for the variance attributable to maternal education and several other potential confounds. ConclusionsTogether, these findings indicate that smoking cessation is associated with reduced risk of having children with academic and neuropsychological difficulties. These outcomes are discussed within the framework that nicotine may be a neurobehavioral teratogen.

Safety and efficacy of inhaled nitric oxide treatment for premature infants with respiratory distress syndrome: follow-up evaluation at early school age

The aims of the study were to assess the long-term safety and compare neurodevelopmental outcomes in school-age children born prematurely who received inhaled nitric oxide or placebo during the first week of life in a randomized, double-blinded study. Children treated with inhaled nitric oxide had previously been shown to have decreased intraventricular haemorrhage and periventricular leukomalacia as newborns and decreased cognitive impairment at 2 years (L.W. Doyle and P.J. Anderson. (2005) Arch Dis Child Fetal Neonatal Ed, 90, F484-F8). It is follow-up study of medical outcomes, neurodevelopmental assessment and school readiness in 135 of 167 (81%) surviving premature infants seen at 5.7±1.0 years. Compared to placebo-treated children (n=65), iNO-treated children (n=70) demonstrated no difference in growth parameters, school readiness or need for subsequent hospitalization. However, iNO-treated children were less likely to have multiple chronic morbidities or technology dependence (p=0.05). They also had less functional disability (p=0.05). These results demonstrate the long-term safety of iNO in premature infants. Furthermore, iNO treatment may improve health status by decreasing the incidence of severe ongoing morbidities and technology dependence and may also decrease the incidence of educational and community functional disability of premature infants at early school age.

Deep Hypothermic circulatory arrest does not impair neurodevelopmental outcome in school-age children after infant cardiac surgery

The purpose of this study was to assess deep hypothermic circulatory arrest (DHCA) as a modifier of neurodevelopmental (ND) outcomes in preschool children after cardiac surgery in infancy for repair of congenital heart defects (CHD). This is a planned analysis of infants enrolled in a prospective study of apolipoprotein E polymorphisms and ND outcome after cardiac surgery. The effect of DHCA was assessed in patients with single or biventricular CHD without aortic arch obstruction. Neurodevelopmental assessment at 4 years of age included cognition, language, attention, impulsivity, executive function, social competence, and visual-motor and fine-motor skills. Patient and procedural variables were evaluated in univariate and multivariate models. Neurodevelopmental testing was completed in 238 of 307 eligible patients (78%). Deep hypothermic circulatory arrest was used at the discretion of the surgeon at least once in 92 infants (38.6%) with a median cumulative duration of 36 minutes (range, 1 to 132 minutes). By univariate analysis, DHCA patients were more likely to have single-ventricle CHD (p = 0.013), lower socioeconomic status (p < 0.001), a higher incidence of preoperative ventilation (p < 0.001), and were younger and smaller at the first surgery (p < 0.001). By multivariate analysis, use of DHCA was not predictive of worse performance for any ND outcome. In this cohort of children undergoing repair of CHD in infancy, patients who underwent DHCA had risk factors associated with worse ND outcomes. Despite these, use of DHCA for repair of single-ventricle and biventricular CHD without aortic arch obstruction was not predictive of worse performance for any ND domain tested at 4 years of age.

5. Cognitive outcomes in school-aged children of epileptic women

5. Cognitive outcomes in school-aged children of epileptic women