Risk factors for inattention, hyperactivity and impaired school performance were examined in 109 children, 5 to 10 years of age, who had undergone newborn cardiac surgery for complex congenital heart disease (CHD) at Children's Hospital of Philadelphia, PA. Data obtained by questionnaires completed by parents and teachers showed that 53 (49%) were enrolled in remedial educational programs, 15% in special education. On an ADHD Rating Scale-lV, 30% received high-risk scores. On a Behavior Assessment System for Children, the number of children with significant scores for inattention and hyperactivity was 3 to 4 times higher than that in the general population. Adverse effects on behavior and learning were not related to pre-,peri-, or post-operative factors, including hypoxemia and CHD. 
COMMENT. School-age children with a history of neonatal cardiac surgery for complex CHD are at increased risk for ADHD and poor performance in math and reading skills. In view of the PDR precautions and contraindications regarding medications for ADHD in children with cardiac disorders, the management of these patients presents a unique challenge for parents, teachers, and physicians. A recent statement released by the American Heart Association advocates screening children routinely for cardiac conditions before and during treatment with stimulant drugs for ADHD.