Behaviour at eight years in children with surgically corrected transposition: The Boston Circulatory Arrest Trial
Behaviour at eight years in children with surgically corrected transposition: The Boston Circulatory Arrest Trial
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DOI：
10.1017/s1047951108003454
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发表时间：
2009-02-01
影响因子：
1
通讯作者：
Rappaport, Leonard A.
中科院分区：
文献类型：
--
作者：
Bellinger, David C.;Newburger, Jane W.;Rappaport, Leonard A.
先天性心脏畸形婴儿在儿童时期患行为障碍的风险程度存在不确定性。作为一项涉及155名接受手术矫正转位（房室和心室动脉连接或排列一致）儿童的随机临床试验的一部分收集了数据。作为婴儿时，他们接受了动脉调转术，采用深低温且主要是完全循环停止或主要是低流量持续性心肺转流作为对重要器官提供支持的方法。在患者4岁和8岁时，家长完成了儿童行为检查表，在8岁时完成了康纳斯家长评定量表。当孩子8岁时，教师完成了教师报告表和康纳斯教师评定量表。在整个队列中，家长和教师所发现的行为问题的频率都有所升高，特别是在儿童行为检查表的能力量表和教师报告表的适应量表上。大约五分之一的患者在儿童行为检查表和教师报告表上的总问题行为得分处于临床关注范围内。然而，根据手术治疗方法，发现的差异很少。术后癫痫发作与社会和注意力问题有关。8岁时出现学业问题的儿童在4岁到8岁之间行为问题的增加比学业进展良好的儿童更大。在婴儿期使用严重血液稀释和α*策略进行修复手术的先天性心脏畸形儿童在童年中期患行为问题的风险增加。
Uncertainty exists regarding the degree to which infants with congenitally malformed hearts are at risk of behavioural disorders in childhood. Data was collected as part of a randomized clinical trial involving 155 children with surgically corrected transposition (concordant atrioventricular and ventriculo-arterial connections or alignments). As infants, they underwent the arterial switch operation, involving deep hypothermia with predominantly total circulatory arrest or predominantly low-flow continuous cardiopulmonary bypass as the method of providing support to the vital organs. Parents completed the Child Behavior Checklist when the patients were aged 4 and 8 years, and the Connors' Parent Rating Scale at the age of 8 years. When the children were aged 8, teachers completed the Teacher's Report Form and the Connors' Teacher Rating Scale. In the cohort as a whole, the frequencies of behavioural problems identified by both parents and teachers were elevated, particularly on the scales for competence of the Child Behavior Checklist, and the Adaptive scales of the Teacher's Report Form. Approximately I in 5 patients had scores for Total Problem Behavior in the range of clinical concern on both the Child Behavior Checklist and the Teacher's Report Form. Few differences were found, however, according to the method of operative treatment. Postoperative seizures were associated with social and attention problems. Children experiencing academic problems at the age of 8 showed a larger increase in behavioural problems between the ages of 4 and 8 than did children making adequate academic progress. Children with congenitally malformed hearts who underwent reparative surgery in infancy using a strategy of severe haemodilution and alpha star are at increased risk of behavioural problems in middle childhood.