Abstract 16919: Third Grade Academic Performance and Episodes of Care Among Children With Congenital Heart Defects

Introduction: Children with Congenital Heart Defects (CHD) may be at risk for poor academic performance in elementary school. Cumulative episodes of care among children with CHD may impact neurocognitive outcomes. We examined the association between the number of episodes of care and third-grade academic performance among children with CHD. Methods: We identified children with CHD from electronic medical records between 1/1/2008 and 12/31/2013 among five North Carolina (NC) tertiary care centers. We classified children by CHD type (severe disease, shunt lesion, valve disease, other) and matched subjects to the NC Department of Public Instruction educational records. We calculated the number of episodes of care by adding inpatient and outpatient visits from the EMR in the follow up period prior to administering the EOG. We estimated the odds of failing third-grade reading or math end of grade (EOG) tests among children with CHD who had episodes of care >50 th percentile compared to children ≤50 th percentile using logistic regression controlling for maternal education, race/ethnicity, and gestational age. We also estimated the average change in the developmental scale score using linear regression for the same comparison group. The inability to demonstrate proficiency in NC grade level standards was considered a failing score. Results: A total of 425 children with CHD had third-grade EOG scores. Of these, 57% were male and 45% of children had a severe CHD, 30% had a shunt lesion, and 21% had valve disease. The median number of episodes of care was 4 (range: 1-60). Children with number of visits above the 50 th percentile (>4 visits) had 2.09 (95% CI: 1.04,4.21) greater odds of failing the math EOG compared to children at or below the 50 th percentile (1-4 visits). The third- grade math developmental scale score declined by 1.54 points (p<0.008) for every 10 episodes of care. There was no statistically significant effect of episodes of care on third grade reading performance. Conclusions: Children with CHD in NC with number of episodes of care above the 50 th percentile, may be at risk for delays in third-grade academic performance. Additional services may be required to improve academic success in this population.