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

Abstract

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.

Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and meta‐analysis

“…Two two‐ventricle studies stated inconsistent associations between ‘clinical illness’ and developmental outcome,37,41 while one study showed no association 52. Of the three studies with mixed lesions, one reported a significant association ‘clinical illness’ and worse motor development32 while the other two showed inconsistent associations between ‘clinical illness’ and developmental outcome 30,56…”

“…Studies that used tests other than the BSID-II and BSID-III also suggested impaired motor development in infancy. 26,28,39,56 Additional outcomes included an increased risk of poorly regulated behavioral states, reduced visual orienting, jitteriness, hypotonia, motor asymmetries, and feeding difficulties. These additional outcomes could be associated with impaired brain Review 33 growth already present before surgery in infants with cyanosis.…”

“…22,30,31,37,[50][51][52]60 The two studies with mixed lesions reported no association between the variables of cerebral protection and developmental outcome. 52,56 Of the preschool set of papers, 11 (four single-ventricle studies, seven two-ventricle studies) reported associations between the variables of cerebral protection and developmental outcome. Of the four single-ventricle studies, none reported significant associations between the variables of cerebral protection and developmental outcome.…”

“…52 Of the three studies with mixed lesions, one reported a significant association 'clinical illness' and worse motor development 32 while the other two showed inconsistent associations between 'clinical illness' and developmental outcome. 30,56 Of the preschool set of papers, seven (three single-ventricle studies, three two-ventricle studies, and one mixed study) reported the associations of 'clinical illness' and developmental outcome. One of the single-ventricle studies identified significant associations between 'clinical illness' and worse motor and cognitive development, 63 while the other two stated inconsistent associations between 'clinical illness' and developmental outcome.…”

Rehabilitation in Pediatric Heart Failure and Heart Transplant

“…For the younger populations, the Alberta Infant Motor Scale (AIMS) (0-18 months) (81), Test of Infant Motor Performance (TIMP) (82) (34 weeks post conceptual age to 4 months) and Peabody Developmental Motor Scales 2 (PDMS-2) (83) (0-5 years of age) are useful tools to assess gross and fine motor skills, identify developmental delay and assign age equivalences when appropriate. The TIMP has been widely used in the congenital heart disease population to assess neuromotor performance before and after open heart surgery (84)(85)(86). In the inpatient setting, limitations in completion of standardized testing may exist due to presence of lines and tubes, post-surgical precautions, or limited tolerance and endurance.…”