Prediction of IQ and Achievement at Age 8 Years from Neurodevelopmental Status at Age 1 Year in Children with D-transposition of the Great Arteries

Objective: Studies of developmental outcomes in children with congenital heart disease (CHD) frequently use assessments conducted in infancy as primary endpoints. Whether test scores of CHD patients in infancy are predictive of status at school age has not been evaluated, however.

Methods: In the Boston Circulatory Arrest Study, 135 children with D-transposition of the great arteries repaired by arterial switch operation were administered the Bayley Scales of Infant Development and the Fagan Test of Infant Intelligence at 1 year of age and the Wechsler Intelligence Scale for Children, Third Edition and the Wechsler Individual Achievement Test at 8 years.

Results: Although most 1-year test scores were significantly associated with 8-year test scores, the amounts of shared variance were modest (<10%). All 1-year test scores had poor sensitivity (16%-32%) and poor positive predictive value (35%-42%) but good specificity (80%-93%) and negative predictive value (78%-79%). More than half of the children with low scores at 8 years (< or =85) had had scores >84 at 1 year.

Conclusion: This pattern suggests that although test scores at 1 year are modestly associated with test scores at 8 years, many children who are at risk for poor late outcomes will not be identified on the basis of 1-year test scores. Long-term follow-up of children with CHD is necessary to draw inferences about the developmental sequelae of preoperative, intraoperative, and postoperative factors.