Behavior Concerns in Preschool Cardiac Surgery Survivors

Background Behavior concerns (BC) are reported in survivors of complex cardiac surgery (CCSx) with inconsistent evidence about health and demographic variables that impact outcomes. Methods Prospective inception-cohort study of infants (without known chromosomal abnormalities) after CCSx from 2001-2017 determined Behavior Assessment System for Children (BASC-II/III) Parent Rating Scales at 4.5 years. T-scores ≥60 for externalizing, internalizing, and behavioral symptom index (BSI), and ≤40 for adaptive behavior defined BC. Potential predictive variables included demographic, acute care, and health factors after initial CCSx. Multiple logistic regression using purposeful selection method gave Odds Ratios (OR) with 95% confidence Intervals (CI). Results Survivors (n=585; 61% boys, 40% single ventricle) were assessed at median age 55 months [interquartile range 53, 57]. Independent predictors were non-cardiac hospitalizations (OR 1.10, 95% CI 1.02, 1.19, p=0.015) for externalizing; non-cardiac 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), single ventricle (OR 1.82, 95% CI, 1.04, 3.17, p=0.035) for internalizing; non-cardiac hospitalizations (OR 1.10, 95% CI 1.02, 1.19, p=0.017), SES (OR 0.98, 95% CI 0.96, 0.10, p=0.031), 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 BSI, indicating more pervasive behaviors. Conclusions Number of non-cardiac hospitalizations predicted increased odds of BC and requires further attention. Improving inpatient trauma-informed care experiences and optimizing access to primary care to prevent non-cardiac hospitalization may be modifiable.