BEHAVIORAL OUTCOME AND QUALITY OF LIFE AFTER NEONATAL ARTERIAL
SWITCH OPERATION IN NEONATES WITH TRANSPOSITION OF THE GREAT ARTERIES
Hövels-Gürich HH, Konrad K, Wiesner M, Herpertz-Dahlmann
B, Messmer BJ, von
Departments of Paediatric Cardiology, Child and Adolescent Psychiatry,
Cardiovascular Surgery, University Hospital, RWTH Aachen, Aachen,
Background - Aims. Behavioral outcome and quality of life
in children between 8 and 14 years of age after neonatal arterial
switch operation for transposition of the great arteries has not
yet been systematically evaluated and is the topic of the present
Methods. 60 unselected children operated as neonates with
combined deep hypothermic circulatory arrest and low flow cardiopulmonary
bypass were evaluated at age 7.9 to 14.3 years (10.5,1.6; mean,
standard deviation) by the Child Behavior Checklist (CBCL) to assess
parent-reported behavioral problems and by the Inventory for the
Assessment of the Quality of Life in Children and Adolescents (IQCL)
to evaluate self-reported quality of life. Results were related
to perioperative status and management, to current neurodevelopmental
status, endurance capacity and sociodemographic factors.
Results. Behavioral outcome on all CBCL problem and competence
scores was worse, whereas quality of life on IQCL scores was not
generally reduced compared to the normal population. In multivariable
analysis, severe preoperative hypoxia was related to parent-reported
social problems; peri-and postoperative cardiocirculatory insufficiency
was associated with internalizing, externalizing, attention and
total behavioral problems. Reduced expressive language was also
found associated with total behavioral problems, and poor academic
achievement was related to parent-reported deficits in school performance.
Impaired neurological status and reduced endurance capacity both
predicted self-reported stress by illness.
Conclusions. The neonatal arterial switch operation with
combined circulatory arrest and low flow bypass is associated with
parent-reported longterm behavioral impairment, but not with self-reported
general reduction in quality of life. Discrepancy between parental
and self-reports may be due to different perception of illness.
In our experience, increased risk of longterm psychosocial maladjustment
after neonatal corrective cardiac surgery is related to the presence
of neurological impairment and reduced endurance capacity.