Children with congenital heart defects were less likely to meet academic standards in reading or math at the end of third grade compared with children who did not have such defects, according to a retrospective cohort study.

The poor testing performance was found in children with critical and noncritical congenital heart disease.

Lead researcher Matthew E. Oster, MD, MPH, of the Emory University School of Medicine in Atlanta, and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on Feb. 21.

Oster said in a news release that it was unclear why children with congenital heart defects struggled in school.

“Most theories relate to factors that are most important in children with severe defects, namely surgical factors, prenatal brain development, time in an intensive care unit or degree of hypoxia,” Oster said.

The researchers identified children in North Carolina who were born from 1998 to 2003 and had congenital heart defects. They also used a random sampling of North Carolina birth certificates of children born from 1998 to 2003 to identify children who had no known birth defects.

For both groups, the researchers linked the birth records with educational records. They had information on 2,807 children with congenital heart defect and 6,355 children with no structural birth defects.

Children with congenital heart defects were less likely to be non-Hispanic white and less likely to have mothers who completed high school by the time of delivery. They were also born an average of two weeks earlier than children born without congenital heart defects. The most common types of defects were atrial septal defects and ventricular septal defects.

The researchers found that 44.6 percent of children with congenital heart defects and 37.5 percent of children without defects did not meet the standards for reading and/or math at the end of third grade. In addition, 20.5 percent and 12.5 percent of the groups, respectively, received exceptional services. The researchers defined exceptional services as individualized educational plans for children with disabilities.

In addition, children with critical and noncritical congenital heart defects were more likely to not meet the standards in reading and/or math and were more likely to have received exceptional services. However, children with noncritical congenital heart defects were less likely to receive exceptional services compared with children who had critical congenital heart defects.

Further, 21.1 percent of the children with congenital heart defects had no additional structural birth defects. Children with other structural birth defects and other noncardiac defects were more likely not to meet the math or reading standards and more likely to receive exceptional services.

The study had a few limitations, according to the researchers, including that they only included children in public schools. They also did not have information on children who were unable to take end-of-grade testing. In addition, they did not have information on surgical interventions or clinical outcomes of children with congenital heart defects.

“By linking three large databases in [North Carolina], we were able to address important knowledge gaps on the neurocognitive out-comes of children with [congenital heart defects],” the researchers wrote. “These children face significant challenges in school performance, and these challenges are not limited to only that subset with critical [congenital heart defects]. Parents and providers of children with all types of [congenital heart defects] should be cognizant of the academic obstacles these children may face and should consider evaluations for exceptional services.”