Eliason Sabrina H Y, Robertson Charlene M T, Bobbitt Susan A, Khademioureh Sara, Dinu Irina A, Joffe Ari R, Acton Bryan V
Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Complex Pediatric Therapies Follow-Up Program, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada.
CJC Pediatr Congenit Heart Dis. 2024 Apr 26;3(4):141-151. doi: 10.1016/j.cjcpc.2024.04.001. eCollection 2024 Aug.
Behaviour concerns (BC) are reported in survivors of complex cardiac surgery (CCSx) with inconsistent evidence about health and demographic variables that impact outcomes.
A prospective inception-cohort study of infants (without known chromosomal abnormalities) after CCSx from 2001 to 2017 determined Behaviour Assessment System for Children (BASC-II/III) parent rating scales at 4.5 years. scores ≥60 for externalizing, internalizing, and the Behavioural Symptoms Index and ≤40 for adaptive behaviour defined BC. Potential predictive variables included demographic, acute care, and health factors after initial CCSx. Multiple logistic regression using the purposeful selection method gave odds ratios (ORs) with 95% confidence intervals (CIs).
Survivors (n = 585; 61% boys, 40% single ventricle) were assessed at a median age of 55 months (interquartile range: 53, 57 months). Independent predictors were noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; = 0.015) for externalizing; noncardiac hospitalizations (OR: 1.14, 95% CI: 1.05, 1.24; = 0.003), female sex (OR: 1.62, 95% CI: 1.04, 2.52; = 0.031), and single ventricle (OR: 1.82, 95% CI: 1.04, 3.17; = 0.035) for internalizing; noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; = 0.017), socioeconomic status (SES) (OR: 0.98, 95% CI: 0.96, 0.10; = 0.031), and years of maternal schooling (OR: 0.91, 95% CI: 0.84, 0.10; = 0.04) for adaptive; and extracorporeal life-saving support (OR: 2.03, 95% CI: 1.01, 3.96; = 0.041) for the Behavioural Symptoms Index, indicating more pervasive behaviours.
The number of noncardiac hospitalizations predicted increased odds of BC and requires further attention. Improving inpatient trauma-informed care experiences and optimizing access to primary care to prevent noncardiac hospitalization may be modifiable.
复杂心脏手术（CCSx）幸存者中存在行为问题（BC），但关于影响结果的健康和人口统计学变量的证据并不一致。
一项对2001年至2017年接受CCSx后的婴儿（无已知染色体异常）进行的前瞻性队列研究，在4.5岁时确定儿童行为评估系统（BASC-II/III）家长评定量表。外化、内化和行为症状指数得分≥60，适应行为得分≤40定义为BC。潜在的预测变量包括初始CCSx后的人口统计学、急性护理和健康因素。使用有目的选择方法的多因素逻辑回归给出了比值比（OR）及95%置信区间（CI）。
对585名幸存者（61%为男孩，40%为单心室）进行了评估，中位年龄为55个月（四分位间距：53, 57个月）。外化行为的独立预测因素是非心脏住院（OR：1.10，95%CI：1.02, 1.19；P = 0.015）；内化行为的独立预测因素是非心脏住院（OR：1.14，95%CI：1.05, 1.24；P = 0.003）、女性性别（OR：1.62，95%CI：1.04, 2.52；P = 0.031）和单心室（OR：1.82，95%CI：1.04, 3.17；P = 0.035）；适应行为的独立预测因素是非心脏住院（OR：1.10，95%CI：1.02, 1.19；P = 0.017）、社会经济地位（SES）（OR：0.98，95%CI：0.96, 0.10；P = 0.031）和母亲受教育年限（OR：0.91，95%CI：0.84, 0.10；P = 0.04）；行为症状指数的独立预测因素是体外生命支持（OR：2.03，95%CI：1.01, 3.96；P = 0.041），表明行为更普遍。
非心脏住院次数预示着BC发生几率增加，需要进一步关注。改善住院患者的创伤知情护理体验并优化初级保健服务以预防非心脏住院可能是可改变的。
