Superior Performance in Prone in Infants With Congenital Heart Disease Predicts an Earlier Onset of Walking

Abstract

Infants with congenital heart disease are at risk of impaired neurodevelopment, which frequently manifests as motor delay during their first years of life. This delay is multifactorial in origin and environmental factors, such as a limited experience in prone, may play a role. In this study, we evaluated the motor development of a prospective cohort of 71 infants (37 males) with congenital heart disease at 4 months of age using the Alberta Infant Motor Scales (AIMS). We used regression analyses to determine whether the 4-month AIMS scores predict the ability to walk by 18 months. The influence of demographic and clinical variables was also assessed. Fifty-one infants (71.8%) were able to maintain the prone prop position (AIMS score of ≥3 in prone) at 4 months. Of those, 47 (92.2%) were able to walk by 18 months compared to only 12/20 (60%) of those who did not maintain the position. Higher AIMS scores were predictive of a greater likelihood of walking by 18 months ( P < .001), with the scores in prone having a higher predictive ability compared to those in other positions (Exp(B) 15.2 vs 4.0). Shorter hospital stays and female gender were also associated with an earlier onset of walking. In conclusion, our study demonstrates that early ventral performance in infants with congenital heart disease impacts the age of acquisition of walking and could be used to guide referral to rehabilitation.

Gross Motor Development of Children with Congenital Heart Disease Receiving Early Systematic Surveillance and Individualized Intervention: Brief Report

“…35 Finally, a recent study of our interdisciplinary team revealed that the ability to maintain the prone prop position in 4-months old infants with CHD resulted in an earlier onset of walking. 28 Altogether, these findings bring additional support to the idea that early motor experience may influence later motor development in high-risk populations and represents a modifiable factor that should be considered by health care professionals to optimize neurodevelopmental outcome.…”

“…These perturbations likely arise from a complex interplay between prenatal, surgical and environmental risk factors that lead to brain injury and dysfunction. 7,21,22 In fact, brain injury acquired during the foetal, the postnatal or the perioperative periods, [23][24][25][26][27] combined with a lack of motor experience, 28 were shown to contribute to these impairments.…”

Impacts of an Interdisciplinary Developmental Follow-Up Program on Neurodevelopment in Congenital Heart Disease: The CINC Study

“…We found no significant differences between groups for gross motor functions. Since gross motor impairments are known to be the first manifestations of altered neurodevelopment in infants with CHD, it is possible that family physicians and pediatricians, even outside specialized clinics, may be successful at detecting these difficulties and thus accurately referred patients to relevant rehabilitation services or offer parental recommendations on how to foster the child's motor development ( 67 ). Based on parental reports, 18% of children in the Historical Control Group had received treatments with a physical therapist in addition to the standard health care, physical therapy being one of the most frequently received interventional services.…”

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

“…10,11,81,82 In addition, factors that are known to be associated with motor developmental delays in children after early cardiac surgery are long-term DHCA, older age at surgery, a higher number of and longer hospital stays, immobilization after one or more open heart surgical procedures, a higher number of days in the intensive care unit, palliative procedures, lower pre-and postoperative neurological scores, presence of microcephaly, history of epileptic seizures, and oxygen saturation levels below 85%. 39,48,50,51,55,[83][84][85][86][87] Although the worst motor developmental scores were seen in children with SVP, studies including children with other CCHD diagnostic groups show relatively low motor scores as well. The study of Sun et al 71 showed smaller brain volumes in children with SVP, TGA, TOF, and IAA compared with other CHD subgroups and healthy controls.…”