Infant Motor Skills After a Cardiac Operation: The Need for Developmental Monitoring and Care

Uzark, Karen; Smith, Cynthia; Donohue, Janet E.; Yu, Sunkyung; Romano, Jennifer C.

doi:10.1016/j.athoracsur.2016.12.032

Cited by 29 publications

(40 citation statements)

References 28 publications

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“…In this study, the incidence of gross motor developmental dysfunction was 68.6%. This statistic is higher than that reported for children after cardiac surgery (incidence 21-64%) [30,32] . The incidence of motor dysfunction was 60% in infants who survived congenital diaphragmatic hernia repair [31] , possibly because of the longer mechanical ventilation time, ICU stay, and more complications in infants and toddlers in the PICU compared with those with post-cardiac surgery.…”

Section: Discussioncontrasting

confidence: 65%

“…Therefore, at this stage, factors such as diseases, environment and nutrition, interfere with the chances of infants and young children receiving external information, which affects their motor development. Uzark et al [30] found that gross motor impairments were common in infants after cardiac operations. Friedman et al [31] showed that young (aged 1-3 years) congenital diaphragmatic hernia survivors continued to have a high incidence of motor and language problems.…”

Section: Discussionmentioning

confidence: 99%

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Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

Yang

Feng

et al. 2019

Preprint

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Background: Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods: This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n=24) or non-dysfunctional (n=11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results: The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r=0.621, P<0.001), and negatively correlated with length of PICU stay (r=-0.556, P=0.001), days sedated (r=-0.602, P<0.001), days on invasive mechanical ventilation (IMV; r=-0.686, P<0.001), and days on continuous renal replacement therapy (CRRT; r=-0.538, P=0.001). Linear regression analysis showed that IMV days (β=-0.736, P=0.001), sepsis (β=-18.111, P=0.003) and PCIS (β=0.550, P=0.021) were independent risk factors for gross motor developmental dysfunction Conclusions: Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis. Trial Registration: The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196. Keywords: Gross Motor Developmental Function; Sepsis; Mechanical Ventilation; Pediatric Intensive Care Unit; Infant; Toddler

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

Yang

Feng

et al. 2019

Preprint

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“…Assessing the trajectory of general movements post-operatively can assist with informing follow-up; however, the absence of pre-operative assessment limits early identification of atypical neurodevelopment and opportunities to modify the environment and care practices. 5 Individualised developmental care approaches have been well established in neonatal ICUs with preterm infants, 45,46 and this approach is now being introduced in cardiac ICUs around the world. 26,47,48 Similarities in clinical vulnerability associated with neurological dysmaturation and intervention requirements demand a similar focus to minimise risk associated with environmental and care practices on long-term neurodevelopment.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24] Focus is shifting to include evaluation of neurodevelopment pre-operatively as an indicator of future neurodevelopmental performance. 5,15,16,25 Preoperative and post-operative neurodevelopmental assessments may identify functional health impairments associated with early CHD management, such as surgical and pharmaceutical interventions and the intensive care environment. Early identification of these impairments informs implementation of neuroprotective measures and clinical management strategies, such as individualised developmentally supportive care, 25,26 and assists with clinical prioritisation and targeted long-term follow-up.…”

mentioning

confidence: 99%

Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age

et al. 2018

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BackgroundEarly identification of infants with CHD at heightened risk of developmental delays can inform surveillance priorities. This study investigated pre-operative and post-operative neuromotor performance in infants undergoing open-heart surgery, and their developmental status at 6 months of age, to identify risk factors and inform care pathways.MethodsInfants undergoing open-heart surgery before 4 months of age were recruited into a prospective cohort study. Neuromotor performance was assessed pre-operatively and post-operatively using the Test of Infant Motor Performance and Prechtl’s Assessment of General Movements. Development was assessed at 6 months of age using the Ages and Stages Questionnaire third edition. Pre-operative and post-operative General Movements performance was compared using McNemar’s test and test of infant motor performance z-scores using Wilcoxon’s signed rank test. Risk factors for delayed development at 6 months were explored using logistic regression.ResultsSixty infants were included in this study. In the 23 (38%) infants. A total of 60 infants were recruited. In the 23 (38%) infants assessed pre-operatively, there was no significant difference between pre- and post-operative performance on the GMs (p=0.63) or TIMP (p=0.28). At discharge, 15 (26%) infants presented with abnormal GMs, and the median TIMP z-score was −0.93 (IQR: −1.4 to −0.69). At 6 months, 28 (52.8%) infants presented with gross motor delay on the ASQ-3, significantly negatively associated with gestational age (p=0.03), length of hospital stay (p=0.04) and discharge TIMP score (p=0.01).ConclusionsPost-operative assessment using the GMs and TIMP may be useful to identify infants requiring individualised care and targeted developmental follow-up. Long-term developmental surveillance beyond 6 months of age is recommended.

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“…It also allows the structural optimization of the reconstructed patch region before the surgical execution, leading improved performance. Particularly, pre-surgical planning of the 3D patch shape will reduce cardiopulmonary bypass time and consequently could influence the probability of post-operative complications 16,38…”

Section: Introductionmentioning

confidence: 99%

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

et al. 2018

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Surgical treatment of congenital heart disease (CHD) involves complex vascular reconstructions utilizing artificial and native surgical materials. A successful surgical reconstruction achieves an optimal hemodynamic profile through the graft in spite of the complex post-operative vessel growth pattern and the altered pressure loading. This paper proposes a new in silico patient-specific pre-surgical planning framework for patch reconstruction and investigates its computational feasibility. The proposed protocol is applied to the patch repair of main pulmonary artery (MPA) stenosis in the Tetralogy of Fallot CHD template. The effects of stenosis grade, the three-dimensional (3D) shape of the surgical incision and material properties of the artificial patch are investigated. The release of residual stresses due to the surgical incision and the extra opening of the incision gap for patch implantation are simulated through a quasi-static finite-element vascular model with shell elements. Implantation of different unloaded patch shapes is simulated. The patched PA configuration is pressurized to the physiological post-operative blood pressure levels of 25 and 45 mmHg and the consequent post-operative stress distributions and patched artery shapes are computed. Stress–strain data obtained in-house, through the biaxial tensile tests for the mechanical properties of common surgical patch materials, Dacron, Polytetrafluoroethylene, human pericardium and porcine xenopericardium, are employed to represent the mechanical behavior of the patch material. Finite-element model is experimentally validated through the actual patch surgery reconstructions performed on the 3D printed anatomical stenosis replicas. The post-operative recovery of the initially narrowed lumen area and post-op tortuosity are quantified for all modeled cases. A computational fluid dynamics solver is used to evaluate post-operative pressure drop through the patch-reconstructed outflow tract. According to our findings, the shorter incisions made at the throat result in relatively low local peak stress values compared to other patch design alternatives. Longer cut and double patch cases are the most effective in repairing the initial stenosis level. After the patch insertion, the pressure drop in the artery due to blood flow decreases from 9.8 to 1.35 mmHg in the conventional surgical configuration. These results are in line with the clinical experience where a pressure gradient at or above 50 mmHg through the MPA can be an indication to intervene. The main strength of the proposed pre-surgical planning framework is its capability to predict the intra-operative and post-operative 3D vascular shape changes due to intramural pressure, cut length and configuration, for both artificial and native patch materials.Electronic supplementary materialThe online version of this article (10.1007/s10439-018-2043-5) contains supplementary material, which is available to authorized users.

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Infant Motor Skills After a Cardiac Operation: The Need for Developmental Monitoring and Care

Cited by 29 publications

References 28 publications

Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

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