School Readiness in Preschool-Age Children with Critical Congenital Heart Disease.

This study examined the nature, variability, and predictors of school readiness difficulties in young children with critical congenital heart disease (CCHD). We hypothesized that, compared to a community control (CC) group, children with CCHD would score less well on measures of readiness and that readiness would be associated with CCHD-related risk factors. Children (60 CCHD and 60 CC) were 4 to 5 years of age and not yet attending kindergarten. Readiness measures included tests of cognition, executive function, motor ability, and pre-academic skills. Caregivers provided child behavior ratings. Analyses examined group differences in readiness, readiness profiles, and associations of readiness with CCHD-related medical risk factors. The CCHD group had lower scores than the CC group on testing and higher caregiver ratings of problems in social communication, as well as higher rates of deficits on several of the measures. Latent class analysis provided evidence for different readiness profiles, with more children with CCHD displaying profiles characterized by weaknesses in readiness. CCHD-related medical risk factors associated with readiness problems in the CCHD group included a co-morbid genetic disorder, postnatal diagnosis of CCHD, major perioperative complication, and longer periods of hospitalizations, cardiopulmonary bypass, and aortic cross-clamp placements. Findings document multiple problems in school readiness in young children with CCHD. Deficits vary across individuals and are associated with higher medical risk. Results confirm the importance of screening for school readiness in these children and suggest areas to target in designing screening measures and providing early childhood interventions.

Treatment of a high output nephrocutaneous urine leak following treatment of a giant calyceal diverticulum in a child.

Calyceal diverticula are non-secretory transitional-epithelium lined cavities that are connected to the collecting system through a small ostium. They are rarely seen in young children. Although most remain asymptomatic, the presence of stagnant urine can result in infection, stone formation and pain. Treatment may consist of percutaneous ablation or open surgical excision. Failure of the ostium to completely seal can result in a persistent leak. We present a case of a massive calyceal diverticulum in a child who developed a postsurgical nephrocutaneous fistula recalcitrant to conservative management that was successfully managed with injection of fibrin glue.