Commentary on “Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis”

Abstract

How could I apply this information?"This review supports the accepted consensus that children who undergo early surgery for congenital heart disease (CHD) have an elevated risk for motor developmental delay and should be routinely and systematically assessed for deviations from typical development across their life course. Implementation of developmental surveillance serves no useful purpose for parents unless referral pathways and intervention services are established, preferably with consideration of local requirements and resource availability. 1 While detailed guidelines exist for risk stratification and the use of serial and standardized multidomain outcome measures, 2-4 embedding developmental care has not been widely realized for children who have CHD due to varying health system barriers. [5][6][7] Collaboratively designed service models between specialists, community clinicians, and families show promise for meaningful change. 1,7 Individualized motor interventions have the capacity to positively influence postoperative recovery and motor outcomes in early infancy for infants who have CHD 8 ; however, significant knowledge gaps remain in understanding neurodevelopmental interventions for this population. 9,10 Interventions should be family-centered, inclusive, and proactive, 11 balanced against the significant lifelong burden of CHD for individuals and their families. 12 "What should I be mindful about when applying this information?"The authors categorized outcomes based on specific cardiac diagnoses with the intent of defining subgroup prevalence and severity of motor delay. However, all CHD diagnoses are not represented, and the low incidence and complexity of individual diagnoses (both included and otherwise) make it unrealistic to study subgroups more definitively with single-center research. Multicenter research and the inclusion of neurodevelopmental outcomes in national registry data 10,13 would allow for more robust consideration of categorized outcomes.The included studies did not exclude premature infants or infants with very low birth weight. For assessment and intervention to be meaningful at an individual level, cardiac disease severity should be considered alongside comorbidities of prematurity, genetic conditions, exposure to invasive procedures, recurrent or prolonged hospital stays, and psychosocial factors. 4,14 The interplay of these factors will be complex, individual, and should not preclude risk stratification and access to intervention for infants who have CHD in the first months of life.