Oster Matthew E, Watkins Stephanie, Hill Kevin D, Knight Jessica H, Meyer Robert E
From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (M.E.O); Department of Cardiology, Children's Healthcare of Atlanta, GA (M.E.O.); Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (M.E.O., J.H.K.); Department of Physical Therapy, Methodist University, Fayetteville, NC (S.W.); Department of Pediatrics, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC (K.D.H.); and Birth Defects Monitoring Branch, State Center for Health Statistics, North Carolina Division of Public Health, Raleigh (R.E.M.).
Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2). doi: 10.1161/CIRCOUTCOMES.116.003074. Epub 2017 Feb 22.
Most studies evaluating neurocognitive outcomes in children with congenital heart defects (CHD) have focused on high-risk patients or used specialized, resource-intensive testing. To determine the association of CHD with academic outcomes and compare outcomes according to the severity of CHD, we linked state educational records with a birth defects registry and birth certificates.
We performed a retrospective cohort study using data from the North Carolina Birth Defects Monitoring Program, North Carolina Department of Public Instruction, and North Carolina Department of Health and Human Services vital records. We performed logistic regression, adjusting for maternal education, race/ethnicity, enrollment in public pre-Kindergarten, and gestational age, to determine the association of CHD with not meeting standards on reading and math end-of-grade examinations in third grade in 2006 to 2012. Of 5624 subjects with CHD and 10 832 with no structural birth defects, 2807 (50%) and 6355 (59%) were linked, respectively. Children with CHD had 1.24× the odds of not meeting standards in either reading or math (95% confidence interval, 1.12-1.37), with 44.6% of children with CHD not meeting standards in at least one of these areas compared with 37.5% without CHD. Although children with both critical and noncritical CHD had poorer outcomes, those with critical CHD were significantly more likely to receive exceptional services compared with the noncritical group (adjusted odds ratio, 1.46; 95% confidence interval, 1.15-1.86).
Children with all types of CHD have poorer academic outcomes compared with their peers. Evaluation for exceptional services should be considered in children with any type of CHD.
大多数评估先天性心脏病（CHD）患儿神经认知结局的研究都集中在高危患者身上，或者使用了专门的、资源密集型的测试。为了确定CHD与学业成绩之间的关联，并根据CHD的严重程度比较结局，我们将州教育记录与出生缺陷登记处及出生证明进行了关联。
我们利用北卡罗来纳州出生缺陷监测项目、北卡罗来纳州公共教育部以及北卡罗来纳州卫生与公众服务部生命记录的数据进行了一项回顾性队列研究。我们进行了逻辑回归分析，对母亲教育程度、种族/民族、公立学前班入学情况和孕周进行了调整，以确定CHD与2006年至2012年三年级阅读和数学期末成绩未达标准之间的关联。在5624名患有CHD的受试者和10832名无结构性出生缺陷的受试者中，分别有2807名（50%）和6355名（59%）被成功关联。患有CHD的儿童在阅读或数学方面未达标准的几率是其他儿童的1.24倍（95%置信区间，1.12 - 1.37），44.6%的CHD患儿在至少一个领域未达标准，而无CHD的儿童这一比例为37.5%。尽管患有严重和非严重CHD的儿童结局都较差，但与非严重组相比，患有严重CHD的儿童接受特殊服务的可能性显著更高（调整后的优势比为1.46；95%置信区间，1.15 - 1.86）。
与同龄人相比，所有类型CHD患儿的学业成绩都较差。对于任何类型CHD患儿，都应考虑进行特殊服务评估。
