Academic Outcomes in Children With Congenital Heart Defects A Population-Based Cohort Study

• Authors: Matthew E. Oster, Emory University; Stephanie Watkins, Methodist University; Kevin D. Hill, Duke University; Jessica H. Knight, Emory University; Robert E. Meyer, North Carolina Division of Public Health
• Journal Title: Circulation: Cardiovascular Quality and Outcomes
• Volume: Volume 10, Number 2
• Publisher: American Heart Association | 2017-02-01, Pages e003074-e003074
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/CIRCOUTCOMES.116.003074
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; birth certificates; child; education; gestational age; heart defects; congenital; registries; NEURODEVELOPMENTAL OUTCOMES; CARDIAC-DISEASE; GREAT-ARTERIES; SURGERY; TRANSPOSITION; SURVIVAL; INFANTS; CLEFTS; RISK

Abstract

Background - Most studies evaluating neurocognitive outcomes in children with congenital heart defects (CHD) have focused on high-risk patients or used specialized, resource-intensive testing. To determine the association of CHD with academic outcomes and compare outcomes according to the severity of CHD, we linked state educational records with a birth defects registry and birth certificates. Methods and Results - We performed a retrospective cohort study using data from the North Carolina Birth Defects Monitoring Program, North Carolina Department of Public Instruction, and North Carolina Department of Health and Human Services vital records. We performed logistic regression, adjusting for maternal education, race/ethnicity, enrollment in public pre-Kindergarten, and gestational age, to determine the association of CHD with not meeting standards on reading and math end-of-grade examinations in third grade in 2006 to 2012. Of 5624 subjects with CHD and 10 832 with no structural birth defects, 2807 (50%) and 6355 (59%) were linked, respectively. Children with CHD had 1.24× the odds of not meeting standards in either reading or math (95% confidence interval, 1.12-1.37), with 44.6% of children with CHD not meeting standards in at least one of these areas compared with 37.5% without CHD. Although children with both critical and noncritical CHD had poorer outcomes, those with critical CHD were significantly more likely to receive exceptional services compared with the noncritical group (adjusted odds ratio, 1.46; 95% confidence interval, 1.15-1.86). Conclusions - Children with all types of CHD have poorer academic outcomes compared with their peers. Evaluation for exceptional services should be considered in children with any type of CHD.