758 - Predicting Preschool Behavioral Outcomes in Early Cardiac Surgery Survivors

Poster Number: 758
Publication Number: 758.304

Sabrina H. Y.. Eliason, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Charlene M. T.. Robertson, University of Alberta, Edmonton, AB, Canada; Susan A. Bobbitt, University of Saskatchewan, Saskatoon, SK, Canada; Sara Khademioureh, School of public health, University of Alberta, Edmonton, AB, Canada; Irina Dinu, University of Alberta, Edmonton, AB, Canada; Ari R. Joffe, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Bryan V. Acton, University of Saskatchewan Psychology Department, Saskatoon, SK, Canada

Background: Behavioral disturbances (BD) are described in children after complex cardiac surgery (CCS).

Objective:

To describe the profile of BD in survivors of CCS done in infancy and identify potential modifiable predictive variables.

Design/Methods:

This prospective inception-cohort outcomes study (part of a longitudinal follow-up project in 6 western Canadian sites) included infants who received CCS at Stollery Children’s Hospital (Edmonton, Alberta). Parent Rating Scales T-scores (by sex) from the standardized Behavior Assessment System for Children (BASC) -II and -III were used to determine BD at 4.5 years of age. T-scores ≥60 for externalizing (hyperactivity, aggression), internalizing (anxiety, depression, somatization), and behavioral symptom index (BSI) (hyperactivity, aggression, depression, attention problems, atypicality, withdrawal) and T-scores ≤40 for adaptive (functional communication, adaptability, social skills, activities of daily living) behavior defined BD. Potential predictive variables included demographic, acute care, and childhood health factors after initial CCS up to age 4.5 years. Multiple logistic regression analyses using purposeful selection method gave Odds Ratios (OR) with 95% confidence intervals (CI).

Results:

585 (70%) of survivors without known chromosomal abnormality (61% boys, 40% single ventricle) born between 2001-2017 were assessed at median (IQR) 55 (53, 57) months of age. BD were externalizing 97 (17%), internalizing 111 (19%), adaptive 146 (25%), BSI 109 (19%). Independent predictors for BD were number of noncardiac hospitalizations (OR 1.10, 95%CI 1.02, 1.19, p = 0.015) for externalizing; number of noncardiac hospitalizations (OR 1.14, 95% CI 1.05, 1.24, p =0.003), female sex (OR 1.62, 95% CI 1.04, 2.52, p = 0.031), single ventricle (OR 1.82, 95% CI, 1.04, 3.17, p = 0.035) for internalizing; number of noncardiac hospitalizations (OR 1.10, 95% CI 1.02, 1.19, p = 0.017), SES (OR 0.98, 95% CI 0.96, 0.10, p = 0.031), years of maternal schooling (OR 0.91, 95% CI 0.84, 0.10, p = 0.04) for adaptive and life-saving support (extracorporeal membrane oxygenation, heart transplantation, or ventricular assist device) (OR 2.03, 95% CI 1.01, 3.96, p = 0.041) for BSI.

Conclusion(s):

Each noncardiac hospitalization after first CCS increased the odds of externalizing, internalizing, and adaptive BD by ~10 %. Future research should examine non-cardiac hospitalizations as a modifiable variable. Higher SES and years of maternal schooling are associated with higher adaptive scores. Other factors are likely not modifiable but may be used to direct resources to those at highest risk of BD.