Division of Neuropsychology, Children's National Health System, Washington, DC; Department of Psychiatry and Behavioral Sciences at The George Washington University School of Medicine, Washington, DC; Department of Pediatrics at The George Washington University School of Medicine, Washington, DC.
Biostatistics, Children's National Health System, Washington, DC; Research Professor of Epidemiology and Biostatistics, George Washington University, Washington, DC.
J Pediatr. 2018 Nov;202:63-69. doi: 10.1016/j.jpeds.2018.07.018. Epub 2018 Sep 19.
To test a model to predict psychosocial quality of life (QOL) in children with congenital heart disease (CHD) via executive dysfunction.
Parents of 91 children with CHD requiring surgery in the first year of life completed questionnaires by mail or as part of their cardiology clinic visit. Latent class analysis identified 2 groups of patients with different likelihoods of executive dysfunction. Select medical and demographic characteristics and executive dysfunction group membership were evaluated as predictors of QOL using structural equation modeling.
In children with CHD, aortic obstruction, male sex, and premature birth predicted worse executive function, explaining 59% of the variance. Structural equation modeling results indicated that executive dysfunction plays an important mediating role, through which CHD with aortic obstruction, male sex, and premature birth indirectly affect psychosocial QOL. Neurologic abnormalities and single-ventricle CHD did not significantly predict executive dysfunction or QOL.
Executive dysfunction is a strong predictor of psychosocial QOL at school age. Select medical and demographic risk factors did not directly predict QOL at school age in CHD; however, aortic obstruction, premature birth, and male sex impacted QOL indirectly by contributing to executive dysfunction. These findings suggest important risk factors for executive dysfunction that can be monitored, allowing for provision of early supports for executive skills development in an effort to improve long term psychosocial QOL in at-risk children with CHD.
通过执行功能测试模型，预测先天性心脏病（CHD）儿童的社会心理生活质量（QOL）。
91 名在生命的第一年需要手术的 CHD 儿童的父母通过邮件或作为其心脏病学诊所就诊的一部分完成了问卷。潜在类别分析确定了两组具有不同执行功能障碍可能性的患者。使用结构方程模型，选择医疗和人口统计学特征以及执行功能障碍组的成员资格作为 QOL 的预测因子进行评估。
在 CHD 儿童中，主动脉阻塞、男性和早产预测了更差的执行功能，解释了 59%的方差。结构方程模型结果表明，执行功能障碍起着重要的中介作用，通过这种作用，主动脉阻塞、男性和早产的 CHD 间接影响社会心理 QOL。神经异常和单心室 CHD 并没有显著预测执行功能或 QOL。
执行功能障碍是学龄期社会心理 QOL 的强烈预测因子。选择医疗和人口统计学风险因素并没有直接预测 CHD 学龄期的 QOL；然而，主动脉阻塞、早产和男性通过导致执行功能障碍，间接地影响 QOL。这些发现表明了执行功能障碍的重要风险因素，可以进行监测，以便为执行技能的发展提供早期支持，从而改善高危 CHD 儿童的长期社会心理 QOL。
