Long-term Behavorial Impairment Reported After Neonatal Arterial Switch Surgery

Parents of children who had undergone a neonatal arterial switch operation with circulatory arrest and low flow bypass report that these children have long-term behavioral problems, German researchers report. However, self-reported quality of life scores were the same as reported in a normal population.

Dr. H.H. Hövels-Gürich from the Aachen University of Technology, and colleagues collected data on 60 children, 8 to 14 years of age, who had undergone deep hypothermic circulatory arrest and low flow cardiopulmonary bypass as neonates.

The researchers assessed the parents of these children with the Child Behavior Checklist and the children with the Inventory for the Assessment of Quality of Life in Children and Adolescents, according to the report in the December issue of the Archives of Disease in Childhood.

Parents reported worse outcomes on all problem and competence scores compared with those reported in a normal population.

Multivariate analysis showed that parents’ reported social problems were related to preoperative hypoxia. Internalizing, externalizing, attention, and all behavioral problems were associated with peri- and postoperative cardiocirculatory insufficiency, the researchers found.

“Reduced expressive language was associated with total behavioral problems, and poor academic achievement was relates to parent reported deficits in school performance,” Dr. Hövels-Gürich’s team reports.

Predictors of self-reported stress by illness included impaired neurologic status and reduced endurance, they add.

Dr. Hövels-Gürich and colleagues emphasize there is a “need to improve pre-, peri-, and postoperative management in neonatal corrective surgery.” They add that “assessing behavioral problems in these children and being aware of parents’ illness-related concerns might be helpful for the early identification of children at risk for psychiatric disorders.”

Arch Dis Child 2002;87:506-510.