{'fraction_non_alphanumeric': 0.03343978959233515, 'fraction_numerical': 0.02987037384933308, 'mean_word_length': 4.9820224719101125, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Psychological Distress in Children with Surgically Corrected Congenital Heart Disease

Purpose/Aim/Objective: The purpose of this study was to investigate the neuropsychological modifications and intellectual functioning parameters (such as predictors of school performance – Intelligence quotient IQ) of children with surgically corrected congenital heart defects. By investigating these changes, we might be able to develop a screening tool which facilitates the early detection of psychological distress, optimizes psychological therapy. Methods: The study was conducted in the Paediatric Cardiology Clinic of Tîrgu Mureș, Romania, between 2016-2018, on 86 children with congenital heart disease (CHD), aged 6 to 17 years old, who have undergone surgical repair compared to 102 healthy controls, matched by age. The study tested the hypothesis that children with CHD have lower intellectual function than the control group and analysed behavioural outcomes for these patients. Exclusion criteria: children aged less than 6 years old, confirmed genetic syndromes and a family history of psychiatric disorders. J Pediatr Perinatol Child Health 2020; 4 (2): 042-051 DOI: 10.26502/jppch.74050040 Journal of Pediatrics, Perinatology and Child Health 43 Results: 59.3% of children in the eligible group were male, with a median age of 11.1 years ± 3.2 SD. The average IQ of the patients with cyanotic CHD was 84.09, while the control group had an average IQ of 91.10. Analysis of the psychological profile indicated that 33.7% of children with surgically corrected CHD had anxiety, and 11.6% of them had attention deficit disorder. Conclusions: Children with surgically corrected cyanotic CHD had a lower IQ than the control group. Anxiety and attention deficit disorder were more frequent in children with CHD.


Introduction
The prevalence at birth of congenital heart diseases (CHD) has a varied geographical distribution, ranging

Material and Methods
Participants were recruited from a tertiary paediatric heart centre in Tîrgu Mures, Romania over a period of three years (2016)(2017)(2018). 86 children, aged between 6 and 18 years old, who underwent surgical repair for CHD during this period were compared to 102 healthy controls. To obtain the study group, a sampling formula depending on the prevalence of CHD in Europe was used. The study group and the control group were matched by age. The primary outcome of the study was to test the hypothesis that children with CHD have reduced intellectual functioning (for example, the best predictor of school performance: IQ) when compared to a healthy population, and that the severity of CHD correlates with the degree of intellectual impairment.
The secondary outcome was to analyse the behavioural patterns of children with surgically corrected CHD. The analysis was conducted based on age, sex and severity of CHD. The results were estimated considering a 95% confidence level. When situations with lack of significance and lack of computation appeared, the conclusion was extracted based on 95% statistical significant confidence level (CI does not include 1) if found relevant. Three categories were considered: 1) the externalizing behaviour, comprising attention deficit, behaviour disorders; 2) the anxiety and 3) the depression.

Results
The study group included 86 subjects, of which 59.3% male, divided as follows: 24 into the mild non-cyanotic category, 18 into the moderate non-cyanotic category and 44 into the cyanotic category. Median age was 11.1 years  3.2 SD. The Anova and the Bonferroni Correction tests were applied to analyse the IQ of the children in the control group and the IQ of the three risk models. One of the hypotheses of this study asserts that children with cyanotic CHD would have a lower IQ, and consequently lower school yield, compared to others (control group or the mild and moderate non-cyanotic).
The results indicated that the mean IQ value in children with cyanotic CHD was 84.09, compared to the control group, with a mean IQ score of 91.10 (p= 0.045) ( Figure   1), also considering the confidence intervals for the mean IQ scores (Table 1). When compared the IQ scores of children corresponding to the NYHA classes, no statistically significant difference was observed (p=0.95) ( Figure 2). A chi-square test was used to analyse the psychological profile for the study group.
Data suggested that 33.7% of children with CHD had anxiety and 11.6% had attention deficit disorders, compared to the control group (p=0.0001) (Figure 3).
Analysing the three risk models in the study group appears that anxiety was similar in children with mild non-cyanotic defects (37.5%) and cyanotic CHD (35.6%) ( Table 2). One of the hypotheses that could not be confirmed is the assumption that the female gender is more prone to neuropsychological disorders than male subjects (p=0.17 and p=0.84) (Figure 4 and 5).

Journal of Pediatrics, Perinatology and Child Health 48
Analysing the incidence of neuropsychological

Discussions
The clinical relevance of the impact of operated CHD

Conclusions
Children with surgically corrected cyanotic congenital heart disease have lower IQ scores than the control group. Anxiety and attention deficit disorders were more frequent in children with CHD.
Racial/ethnic differences in survival of United