Later Competence and Adaptation in Infants Who Survive Severe Heart Defects

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Abstract
A model of risk potential for developmental outcome was created based on cardiac, medical, surgical and family-stress factors in 31 children which transpositon of the great arteries [TGA] who had undergone reparative open heart surgery using cardiopulmonary bypass during infacry. Impact ov these potential risk factors was assessed by 4 current neurologic measures (neurologic anatomic abnormalities, functional impairment. EEG and pattern visual evoked potential [PVEP]) and 4 psychologic measures (IQ, achievement, perceptual-motor function and behavior). Adverse developmental outcome was significantly associated with the following medical risk variables; failure of palliative surgery to alleviate hypoxia, prolonged hypoxa, growth failure, congestive heart failure, absence of amelorating shunting heart defects, storke and CNS infection; and 2 psychosocial moderator variables: socioeconomic status and current life stress. Analysis of a cumulative risk and CNS infection; and 2 psychosocial moderator variables; socioeconomic status and current life stress. Analysis of a cumulative risk score indicated significantly higher risk scores in children with abnormal EEG, PVEP and neurologic examinations. The cumulative risk score highly correlated with composite neurologic outcome (r = 0.62), IQ (r = -0.66), achievement (r = -0.60) and perceptual-motor function (r = -0.48). While overall outcome was favorable for children with TGA who experienced a single risk event, outcome was compromised if multiple risk factors occurred.

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