Behaviour Concerns in Preschool Cardiac Surgery Survivors

Behaviour concerns (BC) are reported in survivors of complex cardiac surgery (CCSx) with inconsistent evidence about health and demographic variables that impact outcomes. A prospective inception-cohort study of infants (without known chromosomal abnormalities) after CCSx from 2001 to 2017 determined Behaviour Assessment System for Children (BASC-II/III) parent rating scales at 4.5 years. T scores ≥60 for externalizing, internalizing, and the Behavioural Symptoms Index and ≤40 for adaptive behaviour defined BC. Potential predictive variables included demographic, acute care, and health factors after initial CCSx. Multiple logistic regression using the purposeful selection method gave odds ratios (ORs) with 95% confidence intervals (CIs). Survivors (n = 585; 61% boys, 40% single ventricle) were assessed at a median age of 55 months (interquartile range: 53, 57 months). Independent predictors were noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; P = 0.015) for externalizing; noncardiac hospitalizations (OR: 1.14, 95% CI: 1.05, 1.24; P = 0.003), female sex (OR: 1.62, 95% CI: 1.04, 2.52; P = 0.031), and single ventricle (OR: 1.82, 95% CI: 1.04, 3.17; P = 0.035) for internalizing; noncardiac hospitalizations (OR: 1.10, 95% CI: 1.02, 1.19; P = 0.017), socioeconomic status (SES) (OR: 0.98, 95% CI: 0.96, 0.10; P = 0.031), and years of maternal schooling (OR: 0.91, 95% CI: 0.84, 0.10; P = 0.04) for adaptive; and extracorporeal life-saving support (OR: 2.03, 95% CI: 1.01, 3.96; P = 0.041) for the Behavioural Symptoms Index, indicating more pervasive behaviours. The number of noncardiac hospitalizations predicted increased odds of BC and requires further attention. Improving inpatient trauma-informed care experiences and optimizing access to primary care to prevent noncardiac hospitalization may be modifiable. Des problèmes de comportement sont signalés chez les enfants ayant subi une intervention chirurgicale cardiaque complexe (ICCC). Or, il existe des incohérences dans les données probantes dont nous disposons sur les variables démographiques ou celles liées à la santé qui peuvent influencer ces résultats. Nous avons mené une étude prospective auprès d’une cohorte initiale de nourrissons (sans anomalie chromosomique connue) ayant subi une ICCC entre 2001 et 2017, pour lesquels les résultats au questionnaire du parent du Système d’évaluation du comportement de l’enfant (Behavior Assessment System for Children, BASC-2/3) ont été obtenus à l’âge de 4,5 ans.