No Drop in I.Q. After Bypass for Child Heart Surgery

The use of cardiopulmonary bypass does not cause short-term neurological problems in children and teenagers after surgery for less complex heart defects, according to pediatric researchers. The new finding contrasts favorably with previous studies that showed adverse neurological effects after newborn surgery for more complex heart conditions.

“This is good news for school-aged children who receive surgery for these less complex heart defects,” said study leader Michael D. Quartermain, M.D., a pediatric cardiologist at The Children’s Hospital of Philadelphia. Quartermain presented the study group’s results at the American Heart Association’s Scientific Sessions today in New Orleans.

The research, conducted at the Cardiac Center of Children’s Hospital, studied 41 patients, aged five to 18, who underwent heart surgery at the hospital while a heart-lung machine circulated their blood (under cardiopulmonary bypass, or CPB). All the patients had milder forms of congenital heart disease usually characterized by an abnormal heart valve or by a hole between the heart’s chambers.

Such defects, while present from birth, are often not detected until a patient is school age or even older. Patients do not show obvious symptoms and are otherwise healthy, but surgical intervention is often recommended to prevent complications later in life. In contrast, more complex congenital heart defects, such as hypoplastic left heart syndrome, a severely underdeveloped ventricle, are life-threatening in infancy, and require urgent surgical repair.

Previous studies of survivors of more complex heart surgery have found neurological problems, such as impaired motor development, lower I.Q. scores and reduced language skills. As medical regimens and surgical techniques have advanced, more recent studies have found milder neurological problems or normal neurological outcomes, but long-term outcomes remain a concern. Likewise, adults with acquired heart disease have sometimes suffered adverse neurological outcomes after surgery with CPB.

In the current study, researchers compared 41 pediatric heart patients who underwent CPB to a control group receiving non-heart-related surgery without CPB. Neurological and developmental testing were performed two weeks before and six months after surgery in both groups. When controlling for the effects of hospitalization and anxiety, the researchers found no significant difference between the two groups in I.Q. scores and tests of memory, motor skills or attention. Neither of the surgical groups showed a decline in neuropsychological scores after surgery.

Regarding the implications of the study, Quartermain said, “It is often challenging for the cardiologist to determine the optimal time to refer a child without symptoms to the operating room for repair of an underlying congenital heart defect. It is now clear that the potential neurodevelopmental sequelae of cardiopulmonary bypass in this group of school-aged patients should not be a major factor in this important decision.”

About The Children’s Hospital of Philadelphia: The Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking third in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

A Growing Problem for Veterans -- Domestic Violence

"The increasing number of veterans with posttraumatic stress disorder (PTSD) raises the risk of domestic violence and its consequences on families and children in communities across the United States," says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis.

"Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs (VA) has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families."

Matthieu and Peter Hovmand, Ph.D., domestic violence expert and assistant professor of social work at Washington University, are merging their research interests and are working to design community prevention strategies to address this emerging public health problem.

"The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence" says Hovmand.

"Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues."

Even as the demographic of the veteran population changes as World War II veterans reach their 80s and 90s and young veterans completing tours of duty in Iraq and Afghanistan, the numbers of living veterans who have served in the United States military is staggering. Current estimates indicate that there are 23,816,000 veterans.

Matthieu says there are evidence-based psychological treatment programs that can be a great resource for clinicians to learn how to identify and treat PTSD symptoms. However, identifying battering behaviors among veterans with active PTSD symptoms may be difficult and may require consultation and referral to domestic violence experts.

Research in the VA shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

"Community violence prevention agencies and services need to be included in a veteran's treatment plan to address the battering behaviors," says Hovmand.

"Veterans need to have multiple providers coordinating the care that is available to them, with each provider working on one treatment goal. Coordinated community response efforts such as this bring together law enforcement, the courts, social service agencies, community activists and advocates for women to address the problem of domestic violence. These efforts increase victim safety and offender accountability by encouraging interorganizational exchanges and communication.

"Veterans Day is an excellent reminder that we need to coordinate the services offered by the VA and in the community to ensure that our veterans and their families get the services they need when they need it," Matthieu and Hovmand say.

New Vaccines for Adults: Which Do You Need?

Most adults are not up to date on their vaccinations, says a new report from Harvard Medical School. The report, Viruses and Infectious Diseases, describes how fast-adapting viruses pose an advancing threat to human health and urges adults to seek out new vaccines and renew their old ones.

The new report explains how viruses and other infections affect the body, and what adults should do to protect themselves. It warns adults not to assume that the vaccines they received as children will protect them for life. Here are some of the reasons adults need vaccination:

• Some adults were never vaccinated as children.

• Newer vaccines were not available when today’s adults were children.

• Immunity can begin to fade over time.

• As you age, you become more susceptible to serious disease caused by common infections.

• You may travel to areas where infectious diseases that are rare where you live are much more common.

• You may come in contact with people who have been exposed to unusual infectious diseases.

The FDA is understandably cautious and very demanding before it will license a new vaccine. But it has recently licensed several vaccines against important infectious agents: HPV (human papillomavirus, which causes cervical cancer), varicella-zoster virus (which causes chickenpox and shingles), and meningococcus (which causes bacterial meningitis). The FDA has also approved a preliminary bird flu vaccine to keep stockpiled in case of a bird flu pandemic. Find out about these and other new vaccines in the Special Section of Viruses and Infectious Diseases, "The newer vaccines: Do you need them?"

Viruses and Infectious Diseases, a 49-page Special Health Report edited by Michael N. Starnbach, Ph.D., Professor of Microbiology, Harvard Medical School, also covers such topics as these:

• Infectious disease in the 21st century

• Transmission of infectious disease

• Common and not-so-common viruses

Simple Blood Test Predicts Obesity

According to new research from the Monell Center, the degree of change in blood triglyceride levels following a fatty meal may indicate susceptibility to diet-induced obesity. The findings open doors to new methods of identifying people, including children, who are at risk for becoming obese.

Triglycerides are a form of fat that is transported in the blood and stored in the body’s fat tissues. They are found in foods and also are manufactured by the body.

“These findings suggest we may someday be able to use a simple blood test to identify those at risk for obesity,” said senior author Mark Friedman, PhD, a behavioral physiologist at Monell. “The ability to identify more susceptible individuals would make it possible to target obesity-prevention resources on those who need them most.”

The global obesity epidemic is thought to be caused in part by consumption of a diet high in fat and carbohydrates, which promotes weight gain. This propensity to gain weight and become obese when consuming a high-fat diet is at least partially controlled by genes, with some individuals gaining more than others while eating the same diet.

In the study, published in the International Journal of Obesity, Friedman and lead author Hong Ji, PhD, screened rats for vulnerability to diet-induced obesity by measuring the increase in blood triglyceride levels following a single high-fat meal. They then fed the rats a diet high in fat over the next four weeks.

The researchers were able to predict which animals would become obese over the four-week period by examining the earlier metabolic response to the high-fat meal: the smaller the triglyceride change, the greater the weight gain.

There currently are no simple biomarkers for predicting susceptibility to diet-induced obesity, and thus no clinical tests that assist physicians in identifying those at risk for becoming obese. The current findings suggest that a change in blood triglyceride levels may someday be used as such a tool.

Future studies will entail a thorough investigation of the mechanism behind differences in the change in blood triglycerides.

“The differences in weight gain associated with high-fat diets indicate that genetically-determined factors contribute to obesity,” notes Friedman. “We have shown that these genetic factors are related to the body’s ability to burn fat. We now need a better understanding of how this relates to blood triglyceride levels.”

Longer term, Friedman, who received a 2008 Guggenheim Fellowship to pursue his studies on diet and obesity, hopes to determine whether such a blood test is predictive of future weight gain in humans.


The Monell Chemical Senses Center is a nonprofit basic research institute based in Philadelphia, Pennsylvania. For 40 years, Monell has been the nation’s leading research center focused on understanding the senses of smell and taste: how they function and affect lives from before birth through old age. Using a multidisciplinary approach, scientists collaborate in the areas of: sensation and perception, neuroscience and molecular biology, environmental and occupational health, nutrition and appetite, health and well being, and chemical ecology and communication. For more information about Monell, visit www.monell.org.