Early-Term Birth in Single-Ventricle Congenital Heart Disease After the Fontan Procedure: Neurodevelopmental and Psychiatric Outcomes

详细信息    查看全文

• 作者：Johanna Calderon ; PhD¹ ; ² ; Christian Stopp ; MS³ ; David Wypij ; PhD³ ; ⁴ ; ⁵ ; David R. DeMaso ; MD¹ ; ² ; Michael Rivkin ; MD⁶ ; Jane W. Newburger ; MD ; MPH³ ; ⁴ ; David C. Bellinger ; PhD ; MSc¹ ; ⁶ ; ⁷
• 关键词：CHD neurodevelopment ; ADHD ; gestational age ; Fontan procedure ; adolescence
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：179
• 期：Complete
• 页码：96-103
• 全文大小：224 K

文摘

To investigate the long-term impact of early-term birth (37-38 weeks' gestation) relative to full-term birth (≥39 weeks' gestation) on neurodevelopmental and psychiatric outcomes in adolescents with single-ventricle congenital heart disease (CHD).

Study design

This cross-sectional cohort study analyzed retrospective medical records from full term adolescents with single-ventricle CHD who underwent the Fontan procedure. Participants underwent neurodevelopmental and psychiatric evaluations, as well as structural brain magnetic resonance imaging. Early-term born adolescents were compared with full-term born adolescents using regression models with adjustments for family social status, birth weight, and genetic abnormality status. Medical and demographic risk factors were examined as well.

Results

Compared with the full-term group (n = 100), adolescents born early term (n = 33) scored significantly worse on daily-life executive functions, as measured by the Behavior Rating Inventory of Executive Function parent-report (mean scores: early term, 62.0 ± 10.9; full-term, 55.6 ± 12.2; P = .009) and self-report (P = .02) composites. Adolescents born early term were more likely than those born full term to have a lifetime attention-deficit/hyperactivity disorder (ADHD) diagnosis (early term, 55%; full term, 26%; P = .001). The early-term group also displayed greater psychiatric symptom severity, as indicated by the clinician-reported Brief Psychiatric Rating Scale (mean score: early term, 16.1 ± 8.6; full-term, 12.5 ± 8.2; P = .007).

Conclusion

Early-term birth is associated with greater prevalence of executive dysfunction, ADHD diagnosis, and psychiatric problems in adolescents with single-ventricle CHD. Early-term birth should be included as a potential risk factor in the algorithm for closer developmental surveillance in CHD.