School outcomes in children registered in the studies for pediatric liver transplant (SPLIT) consortium

Abstract

Pediatrics, Children's Memorial Hospital, Chicago, IL School performance is an important aspect of functional outcomes for pediatric liver transplant (LT) recipients. This longitudinal analysis conducted through the Studies of Pediatric Liver Transplantation (SPLIT) research consortium examines several indicators of school function in these patients. A total of 39 centers participated in data collection using a semistructured questionnaire designed specifically for this study. The survey queried school attendance, performance and educational outcomes including the need for special educational services. Participants included 823 of 1133 (73%) eligible patients, mean age 11.34 6 3.84 years, 53% female, median age at LT 4.6 (range 0.05-17.8) years, and mean interval from transplant was 5.42 6 2.79. Overall, 34% of patients were receiving special educational services and 20% had repeated a grade, with older participants more likely to have been held back (P ¼ 0.0007). Missing more than 10 days of school per year was reported by one-third of the group, with this level of absence being more common in older participants (P ¼ 0.0024) and children with shorter intervals from LT (P < 0.0001). Multivariate analysis revealed the following factors were associated with the need for special educational services; type of immunosuppression at 6 months post-LT, cyclosporine A (odds ratio [OR] ¼ 1.8, confidence interval [CI] ¼ 1.1-3.1), or other (OR ¼ 4.9, 95% CI ¼ 1.4-17.6) versus tacrolimus, symptomatic cytomegalovirus infection within 6 months of liver transplantation (OR ¼ 3.1, CI ¼ 1.6-6.1), and pretransplant special educational services (OR ¼ 22.5, CI ¼ 8.6-58.4).

Participação e necessidade de assistência na realização de tarefas escolares em crianças com paralisia cerebral

“…Uma vez que a educação é considerada um bemestar relacionado à saúde (4), o número de crianças com incapacidades, inseridas em classes do ensino regular, aumentou (6, 7) a partir da implementação da legislação brasileira que promove a inclusão escolar (8,9). Acredita-se que no ambiente escolar as crianças com necessidades especiais podem alcançar o mais completo progresso educacional e de integração social (10). No entanto, o potencial benéfi-co da inclusão escolar de crianças com PC tem sido pouco examinado na literatura (11,12).…”

Long-term nutritional and cognitive outcomes after liver transplantation in childhood

“…Our study controlled for some of these pretransplant factors including genetic potential and environmental influences because we compared patients to their siblings, as well as to the normal population. Growth deficit at transplant, and requirement for tube feeding pre-transplant were also significantly correlated with need for special education on univariate analyses of SPLIT data, implying the effects of malnutrition 110 . The improved nutritional state of our cohort therefore may be the reason for improved cognitive outcomes compared to previous studies.…”

“…The strongest predictor for post-transplant special educational assistance in the SPLIT studies however, was the requirement for it pre-transplant, odds ratio 22.5, indicating that pre-transplant factors such genetic potential, family environment, malnutrition and underlying disease were more significant than transplantation and immunosuppression on long-term cognition 110 . Our study controlled for some of these pretransplant factors including genetic potential and environmental influences because we compared patients to their siblings, as well as to the normal population.…”

“…repeating a grade at school 110 . Interestingly, the best predictor for needing education support in this cohort was the requirement for it pre-transplant, Odds Ratio 22.5, which…”

“…suggests that pre-transplant factors are important 110 . In contrast, a Belgian study reported There is again limited and conflicting information on psychosocial outcomes after liver transplantation.…”