Creighton Dianne E, Robertson Charlene M T, Sauve Reg S, Moddemann Diane M, Alton Gwen Y, Nettel-Aguirre Alberto, Ross David B, Rebeyka Ivan M
Cardiorespiratory Services, Alberta Children's Hospital, Calgary, Alberta, Canada.
Pediatrics. 2007 Sep;120(3):e478-86. doi: 10.1542/peds.2006-3250.
This work provides neurocognitive, functional, and health outcomes for 5-year survivors of early infant complex cardiac surgery, including those with chromosomal abnormalities.
Of 85 children (22.4% mortality), 61 received multidisciplinary, individual evaluation and parental questionnaires at 5 years. Full-scale, verbal, and performance IQ scores were compared by using analysis of variance among children who received different surgeries (arterial switch, 20; Norwood for hypoplastic left heart syndrome, 14; simple total anomalous pulmonary venous connection, 6; miscellaneous, 21; and chromosomal abnormalities, 8). Predictions from mental scores at 2 years for IQ scores at 5 years were determined.
Children with chromosomal abnormalities had lower full-scale and verbal IQs at 5 years than other survivors, with no differences found among the remaining groups. For children post-Norwood, performance IQ scores remained lower than for children after the arterial-switch operation. Prediction of full-scale IQ (<70) from 2-year mental scores for all 61 children were as follows: sensitivity, 87.5%; specificity, 88.1%; positive predictive value, 53.8%; and negative predictive value, 97.9%. For full-scale IQ of <85, predictions were 90.0%, 87.8%, 78.3%, and 94.7%, respectively. For those 53 without chromosomal abnormalities, full-scale IQ <70, respective predictions were 86.7%, 90.0%, 28.6%, and 97.8%, and for full-scale IQ <85, respective predictions were 85.7%, 89.7%, 75.0%, and 94.6%. Parental report indicated good health in 80% and adequate function in 67% to 88% of the children, although health-utilization numbers suggest that these reports are optimistic.
Five-year full-scale and verbal IQs were similar among groups, excluding those with chromosomal abnormalities. Children with chromosomal abnormalities had the lowest scores. Excluding those with chromosomal abnormalities, the mean mental scores for the children as a group tended to increase from 2 to 5 years of age, with an overall high percentage of correct classifications at 2 years.
本研究提供了早期婴儿复杂心脏手术5年幸存者的神经认知、功能和健康结局，包括那些患有染色体异常的患儿。
85名儿童（死亡率为22.4%）中，61名在5岁时接受了多学科、个体化评估及家长问卷调查。通过方差分析比较接受不同手术的儿童（动脉调转术20例；用于左心发育不全综合征的诺伍德手术14例；单纯完全性肺静脉异位连接6例；其他21例；染色体异常8例）的全量表、言语和操作智商得分。确定了2岁时心理得分对5岁时智商得分的预测情况。
染色体异常的儿童在5岁时的全量表和言语智商低于其他幸存者，其余组间未发现差异。接受诺伍德手术后的儿童，其操作智商得分仍低于接受动脉调转术的儿童。对所有61名儿童，根据2岁时心理得分预测全量表智商（<70）的结果如下：敏感度87.5%；特异度88.1%；阳性预测值53.8%；阴性预测值97.9%。对于全量表智商<85，预测值分别为90.0%、87.8%、78.3%和94.7%。对于53名无染色体异常的儿童，全量表智商<70时，相应预测值分别为86.7%、90.0%、28.6%和97.8%；全量表智商<85时，相应预测值分别为85.7%、89.7%、75.0%和94.6%。家长报告显示，80%的儿童健康状况良好，67%至88%的儿童功能正常，尽管医疗利用数据表明这些报告较为乐观。
排除染色体异常的儿童，各手术组间5岁时的全量表和言语智商相似。染色体异常的儿童得分最低。排除染色体异常的儿童，总体上该组儿童的平均心理得分从2岁到5岁呈上升趋势，2岁时正确分类的总体比例较高。
