COGNITIVE FUNCTION AND BEHAVIORAL STATUS IN PEDIATRIC HEART AND HEART-LUNG TRANSPLANT RECIPIENTS - THE HAREFIELD EXPERIENCE

Objective-To assess the psychological impact of cardiac and cardiopulm onary transplantation on children. Design-Retrospective cross sectiona l study. Setting-One British centre performing paediatric heart and he art-lung transplant operations, four cardiac units in London, three Lo ndon schools, two London health centres, and the dental department of a London children's hospital. Subjects-65 children who had been given heart or heart-lung transplants and two reference groups of 52 childre n who had had other types of cardiac surgery and 45 healthy children. Main outcome measures-Development, cognition, and behaviour at home an d at school as assessed by measures with proved validity and reliabili ty. Results-Developmental and cognitive measures indicated that childr en given transplants had significantly lower scores on several paramet ers, particularly in terms of development in children under 41/2 years of age. Performance on all tests, however, was within the normal rang e. There were no significant differences in behavioural ratings betwee n the transplant and reference groups, though problem behaviour at hom e was more prevalent in the transplant group. Conclusions-Though cogni tive development may be within the normal range, there are adverse psy chological effects associated with cardiac and cardiopulmonary transpl antation. These data indicate the need for a controlled prospective st udy in which children and their families are seen before and at regula r intervals after transplantation. Interventions should he-developed t hat are tailored to the particular needs of this very specialised grou p of paediatric patients and their families.