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["Additional file 1: Table presenting psychological adjustment in children and adolescents with CHD after CPB surgery grouped by major outcome variables and methodological quality"]
[]
["study reference\n(reference no.) ","quality\nrating\n(0-11)","design","sample size\n(% males);\nresponse rate","diagnoses","time/type of \nsurgery\n(% with CPB)","exclusion \ncriteria","age at 1st \nsurgery/\nat follow up","follow up \ninterval       (mean)","controls","assessed \nrisk factors","outcome","resultsa"]
["Alden\net al. 1998\n(18)",9,"cross-\nsectional","31 (68)\n100%","TGA","born: 1964-1983\nSenning, Mustard\n(100)","rapid health\ndeterioration","mean: 1.6 yrs\nmean: 13.2 yrs","11.5 yrs","norms","cardiac status\nIQ","DSM-IV\ndiagnosis\n(CBPI)\n\nSelf:\nITIAS\n","· 19% with  DSM-IV diagnosis (e.g., separation \n  anxiety, social phobia, oppositional defiant \n  disorder)\n· = self esteem\n\ntested associations:\n· need for re-operation related to more psychological  difficulties  \n· no effect for: IQ"]
["Bjornstad\net al. 1995\n(19)\n",7,"cross-\nsectional","26 (62)\n87%","severe\ncyanotic CHD","n.r.\ncorrective/palliative\n(>69)","blindness;\ncongenital\nanomalies","n.r.\nmean: 16.3 yrs","> 2 yrsc","no controls","physical \ncapacity","DSM-IV\ndiagnosis\n(CAS)\n\nproxy:\nCBCL","· 46% with at least one DSM-IV diagnosis, mostly \n  from the affective spectrum\n· 19% with significant behavioral difficulties\n\ntested associations:\n· physical capacity related to psychological and \n  psychosocial functioning"]
["Mc Cusker \net al. 2007\n(20)",7,"cross-\nsectional","90 (n.r.)\n60%","cyanotic + acyanotic CHD","n.r.                            Corrective/palliative    \n (62%)","developmental and psychiatric syndromes","mean: 0.8 yrs         \nmean: 4.6 yrs                 ","3.8 yrs","mild CHD (n=19)  closed surgery CHD (n=34)         norms","severity of CHD; palliative status; perioperative course; maternal mental health and worry; parenting style; family functioning; family social support; SES","Proxy:\nCBCL\n","· - proxy-reported overall behavior for children with cyanotic-complex     CHD\n\ntested associations:\n. No association between surgical procedure, duration of bypass and proxy-reported behavior\n· parenting style, maternal mental health and worries related to proxy-reported behavioral"]
["Oates \net al. 1994\n(21)\n",7,"cross-\nsectional","168 (n.r.)\n87%","TGA\nTOF\nVSD\nASD","1972-1982\n(100)","neurological, \nintellectual\nimpairment","mean: <3.4 yrs\nmean: 10 yrs","4-8 yrs","healthy \ncontrols"," -","Proxy:\nCBCL;\nTRF","parental reports:\n· - overall and internalizing behavior \n· - clinically relevant disturbances\n· - social competence according to parents\nteacher reports: \n· = overall behavior"]
["Wright \net al. 1994\n(22)\n",8,"cross-\nsectional","29 (69)\n76%","TGA\nTOF","1979-1984\nTGA: Senning\n(100)","non-cardiac\nmalformation","mean: 10 months\nmean: 9.5 yrs","> 2 yrsc","norms;\ninnocent\nmurmur;\nspontaneous\nclosure"," - ","Proxy:\nCBCL\nTRF","· = overall, internalizing, and externalizing \n     behavior according to parents and teachers\n· - behavioral maladjustment rate (i.e., 41% scored\n    more than 1 sd above the mean of the norm)"]
["Gupta\net al. 1998\n(23)\n",8,"cross-\nsectional","39 (38)\n98%","cyanotic/\nacyanotic CHD","n.r.\n(>50)","n.r.","n.r.\nmean: 10.1 yrs","> 2 yrsc","norms","cyanosis;\nparental anxiety","Proxy:\nCBCL\n\nSelf:\nFSSC-R;\nCMAS-R;\nCDI\n\n","· - proxy-reported overall and internalizing behavior\n· = self-reported overall fear, anxiety\n· - fear of injury, medical fear\n\ntested associations:\n· more behavioral difficulties in cyanotic than in acyanotic CHD\n· maternal anxiety related to proxy-reported behavior and the self-  perceived fear in children"]
["Hovels-Gurich\n et al. 2002\n(24)\n",7,"cross-\nsectional","60 (77)\n78%","TGA\nTGA/ VSD\nTGA/ CoA","1986-1992\nASO\n(100)","no exclusion","n.r.\nmean: 10.5 yrs","> 2 yrsc","norms","pre-, peri-, post-\noperative data;\nlanguage deficits","Proxy: \nCBCL\n","· - overall, internalizing, and externalizing \n    behavior\n\ntested associations:\n· peri-, postoperative cardiocirculatory insufficiency,   \n  severe pre-operative hypoxia, DHCA, and \n  language deficits related to behavioral difficulties\n"]
["Mahle\net al. 2000\n(25)\n",6,"cross-\nsectional","28 (n.r.)\n82%","HLHS","1982-1991\nstaged palliation\n(100)","interrupted\naortic arch;\nheterotaxy","< 1 month\nmean: 8.9 yrs","> 2 yrsc"," - "," - ","Proxy:\nCBCL","· 50% with significant behavioral difficulties"]
["Miatton\n et al. 2007\n(26)",6,"cross-\nsectional","18 (55)\n86%              ","TOF","1995-1999\n (100)","perinatal problems; genetic abnormalities; non-cardiac malformations; \nbirth weight < 2000 g","mean: 17.3 days     mean: 8.3 yrs","> 2 yrsc","acyanotic CHD    healthy controls","type of CHD","Proxy:\nCBCL\n","· - proxy-reported overall behavior                                                         \n. - proxy-reported attention problems\n\ntested associations:\n. No significant differences between TOF and acyanotic CHD\n\n"]
["Spijkerboer \net al. 2008\n(27)",8,"cross-\nsectional","proxy:  124 (53)              \n73%\nself 84 (52)\n73%","ASD\nVSD\nTGA          PS","1990-1996\n (90)               ","syndromes associated with mental retardation","proxy: 0.3-3.2 yrs\nself: 0.2-3.4 yrs\n\nproxy: 10.4-14.0 yrs\nself: 11.5-14.4 yrs","> 2 yrsc","norms (Dutch)","cardiac diagnosis; age at follow up, sex","Proxy:\nCBCL\n\nSelf:\nYSR","· - proxy-reported overall behavior, particularly for males\n· + self-reported: less rule breaking behavior for CHD\n\ntested associations:\n· larger differences between CHD and controls for younger age\n. Parents of children with VSD report more behavioral problems than parents of children with ASD and PS"]
["Brosig \net al. 2007\n(28)",5,"cross-\nsectional","26 (73)                53%","HLHS          TGA","1996-1999\nTGA: ASO\n(100)","major congenital anomalies, severe medical conditions","median: 4 (HLHS); 5 (TGA) days   \nmean: 4.7 yrs","> 2 yrsc","norms","parental stress","Proxy:\nCBCL\n","for HLHS: - overall, attention and externalizing behavior            "]
["Goldberg\net al. 2000\n(29)\n",4,"cross-\nsectional","61 (66)\n58%","HLHS","1989-1996\nFontan\n(100)","n.r.","< 2 months\nmean: 4.8 yrs","> 2 yrsc","non-HLHS-\nFSV malfor-\nmation"," - ","Proxy:\nCBCL\nVABS","· = internal, external, overall behavior, \n  communication, socialization, and daily living \n  skills\n· no effect for type of malformation"]
["Ellerbeck \net al. 1998\n(30)\n",6,"cross-\nsectional","55 (61)\n92%","TGA","born: 1981-1990\nSenning, Mustard,\nASO","prematurity;\nchromosomal\nanomalies;  \nsignificant\nhead injury","mean: \n< 4.5 months\nmean: 8.2 yrs","> 2 yrsc","norms (percentile);\nsiblings\n(n=35)","Mustard/ Senning\nvs. ASO","Proxy: \nCBCL\n","· 33% above 90th percentile for overall behavioral \n  problems (n=55)\n· = overall behavioral problems, based on matched\n  pair sibling analysis (35 pairs)\n· more behavioral problems in patients without \n  sibling (n=20)\n\ntested associations:\n· no effect for type of surgical repair"]
["Visconti \net al. 2002\n(31)",10,"prospective","1 yr: 143 (75)\n92%\n4 yrs: 152 (76)\n97%","TGA \nwith/ without VSD","1988-1992\nASO\n(100)","n.r.","mean:< 3 months\nmean: at 1 and \nat 4 yrs","1st: 1 yr\n2nd: 4 yrs","norms","parental stress;\nsocial support","Proxy: \nCBCL\n","· = overall and externalizing behavior; \n· + internalizing behavior\n\ntested associations:\n· early parental distress related to behavioral adjustment when the child is aged 1 and 4 yrs\n· no effect for social support"]
["Bellinger\net al. 1997\n(32)\n",8,"cross-\nsectional","113 (n.r.)\n68%","TGA\nTGA/VSD","1988-1992\nASO\n(100)","congenital, extracardiac\nanomalies;\nbirth weight\n < 2500g","mean:< 3 months\nmean: 2.6 yrs","2 yrs","norms","DHCA vs. CPB;\nexpressive language","Proxy:\nCBCL","· + behavior\n\ntested associations\n· DHCA group with more overall and internalizing behavior than CPB \n· expressive language delay related to more\n  behavioral difficulties"]
["Karl\net al. 2004\n(33)\n\n",7,"cross-\nsectional","74 (n.r.)\n40%","TGA-IVS","1988-1994\nASO\n(100)","complex TGA","median:9 days\nmedian: 9.1yrs","> 2 yrsc","\"best friend\"\ncontrols"," - ","Proxy:\nCBCL\nTRF","· - parent-reported overall competence and  behavi\n\n· - teacher-reported withdrawal, restlessness, and inattention \n   \n· = social functioning"]
["Salzer-Muhar\net al. 2002\n(34)\n",5,"cross-\nsectional","48 (69)\n79%","TGA\nTOF\nother","n.r.\ncorrective/palliative\n(>50)","congenital and extracardiac anomalies","n.r.\nmean: 13.7 yrs","n.r.","healthy \ncontrols"," -","Self: \nYSR; \nFSKS; HSPQ;\nSTAI\n\n","· = overall behavior\n· + anxiety\n· + super ego strength\n· - self esteem and physical capacity in males\n"]
["Utens \net al. 19932\n(35)\n",7,"cross-\nsectional","proxy report: 144 (59)\n87%\nself report:179 (59)\n87%","VSD\nTGA\nTOF\nPS\nother","1968-1980\n(100)","Trisomy 21 syndrome","< 15 yrs\n\nproxy: 10-12 yrs\nself: 11-17 yrs",">9 yrs","norms","cardiac diagnosis;\nIQ","Proxy:\nCBCL\n\nSelf:\nYSR","· - self-reported behavior\n· - proxy-reported overall behavior\n\ntested associations:\n· lower IQ related to more proxy-reported behavioral difficulties\n· no effect for: cardiac diagnosis"]
["Miatton\n et al. 2007\n(36)",7,"cross-\nsectional","43 (51)\n26%","ASD\nVSD\nTGA\nTOF \nother","1995-1999\n (100)","non-cardiac\nmalformation","median: 2 month           mean: 8 yrs 8 month","> 2 yrsc","matched controls (age, sex, SES)","sex, neonatal, surgical variables, physical capacity","Proxy:\nCBCL\n\nSelf:\nSelf Perception for Children; Children's Depression Inventory; STAI\n\n","· - proxy-reported overall behavior\n. - proxy-reported social behavior, attention, aggression\n. - self-reported depressive symptoms"]
["De Maso \net al. 1990\n(37)\n",7,"cross-\nsectional","140\nn.r.","TGA\nTOF","1968-1972\nTGA: Mustard; Blalock Hanlon; TOF: shunt or repair\n(>66)","n.r.","n.r.\nmean: 5.7 yrs","> 2 yrsc","spontaneous\nrecovery","cardiac diagnosis;\nCNS impairment\nIQ; sex","Combined:\nglobal functioning\nscore"]
["Spijkerboer \net al. 2008\n(38)",8,"cross-\nsectional","proxy:  90 (50)              \n75%\nself 84 (52)\n73%","ASD\nVSD\nTGA          PS","1990-1996 \n(90)               ","syndromes associated with mental retardation","proxy: 0.2-3.1 yrs           \nself: 0.2-3.6 yrs\n\nproxy: 12.2 yrs\nself: 13.0 yrs","> 2 yrsc","historical control  (Utens et al. 1998)","cardiac diagnosis; age at follow up, sex","Proxy:\nCBCL\n\nSelf:\nYSR","· = proxy- and self reported behavior between study group and historical control\n\ntested associations:\n· no effect for cardiac diagnosis\n\n\n"]
["Utens\net al. 19982\n(39)\n",7,"cross-\nsectional","144 (59)\n87%","ASD\nVSD\nTGA\nTOF \nother","1968-1980\n(100)","Trisomy 21 syndrome","< 15 yrs\nmean: 12.6 yrs","11.9 yrs","no controls","medical history;\nperi-, postoperative data;\nextracardiac \ncomorbidities;\nsex, age","Proxy:\nCBCL\n","tested associations:\n· higher number of heart surgeries and DHCA \n  related to more behavioral and emotional \n  difficulties\n· no effect for: cardiac diagnosis, extracardiac\n  comorbidities"]
["Kern \net al. 1998                        (40)\n",8,"cross-\nsectional","14 (57)\n100%","HLHS","1990-1996\nNorwood\n(100)","< 2 surgical \nstages","mean: >8 days\nmean: 4.4 yrs","2.8 yrs","norms; \nsiblings","duration of stage 1 CPB and CA;\nsurgical age;\nno. of surgeries ","Proxy:\nVABS","· - daily functioning, communication, social skills and motor ability\n\ntested associations:\n· no effect for perioperative data"]
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["a main results are summarized by means of; \"=\" indicating missing differences between cases and controls/norms; \"+\" indicating a better outcome compared to controls/norms; \" - \" indicating a "]
["   negative outcome compared to controls/norms"]
["b preliminary data"]
["c estimated from reported data"]
["1 Boston cohort study; 2 Rotterdam cohort study"]
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["Abbreviations: no. - number; n.r. - not reported; QoL - quality of life, yrs - years  "]
["Abbreviations of CHD diagnoses: AS - aortic stenosis; ASD - atrial septum defect; CAT - common arterial trunk; DILV - double inlet ventricle; HLHS - hypoplastic-left heart syndrome; "]
["PA -IVS -  pulmonary atresia with intact ventricular septum; PS - pulmonary stenosis; TOF - tetralogy of fallot; TGA - transposition of the great arteries; VSD - ventricle septum defect  "]
["Abbreviations of surgical intervention: ASO - arterial switch operation "]
["Abbreviations for control groups: ADHD - attention deficit and hyperactivity disorder; FSV - functional single ventricle; JRA - juvenile rheumatoid arthritis; "]
["Abbreviations for risk factors: CA - circulatory arrest; CPB - cardiopulmonary bypass; DHCA - deep hypothermic circulatory arrest; IQ - intelligence quotient; SES - socioeconomic status"]
["Abbreviations for  measures of psychological adjustment: CAS - Child Assessment Schedule; CBCL - Child behavior Checklist; CBPI - Child Behavior Problems Interview; CDI . Child Depression Inventory; "]
["CMAS - Child Manifest Anxiety Scale; FSKN - Frankfurt Selbstkonzeptskalen (self concept); FSS-R - Fear Survey Scale-revised; HSPQ - High School Personality Questionnaire; ITIAS - I Think I Am Scale; STAI - State Trait "]
["Anxiety Inventory; TRF - Teacher Report Form; VABS - Vineland Adaptive Behavior Scales; YSR - Youth Self Report  "]