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

Published online by Cambridge University Press:  24 October 2018

Miranda J. Campbell ,
Jenny M. Ziviani ,
Christian F. Stocker ,
Asaduzzaman Khan  and
Leanne Sakzewski
Miranda J. Campbell*
Affiliation:
Children’s Health Queensland, Brisbane, Queensland, Australia School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
Jenny M. Ziviani
Affiliation:
School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
Christian F. Stocker
Affiliation:
Children’s Health Queensland, Brisbane, Queensland, Australia
Asaduzzaman Khan
Affiliation:
School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
Leanne Sakzewski
Affiliation:
Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
*
Author for correspondence: M. J. Campbell, Occupational and Music Therapy Department, Level 7 Lady Cilento Children’s Hospital, 501 Stanley Street, South Brisbane, QLD 4101, Australia. Tel: +617 3068 1111; E-mail: miranda.campbell@health.qld.gov.au
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Abstract

Background

Early 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.

Methods

Infants 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.

Results

Sixty 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).

Conclusions

Post-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.

Keywords

Cardiac surgeryneurodevelopmentdevelopmental surveillanceCHDother

Information

Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 2 , February 2019 , pp. 100 - 109
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Campbell MJ, Ziviani JM, Stocker CF, Khan A, Sakzewski L. (2018) Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age. Cardiology in the Young page 100 of 109. doi: 10.1017/S1047951118001622

References

1. Snookes, S, Gunn, J, Eldridge, B, et al. A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 2010; 125: E818–E827.10.1542/peds.2009-1959Google Scholar
2. Marino, SB, Lipkin, HP, Newburger, WJ, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management. A scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.10.1161/CIR.0b013e318265ee8aGoogle Scholar
3. Brosig, C, Butcher, J, Butler, S, et al. Monitoring developmental risk and promoting success for children with congenital heart disease: recommendations for cardiac neurodevelopmental follow-up programs. Clin Pract Pediatr Psychol 2014; 2: 153–165.10.1037/cpp0000058Google Scholar
4. Chorna, O, Baldwin, HS, Neumaier, J, et al. Feasibility of a team approach to complex congenital heart defect neurodevelopmental follow-up: early experience of a combined cardiology/neonatal intensive care unit follow-up program. Circ Cardiovasc Qual Outcomes 2016; 9: 432–440.Google Scholar
5. Uzark, K, Smith, C, Donohue, J, Yu, S, Romano, JC. Infant motor skills after a cardiac operation: the need for developmental monitoring and care. Ann Thorac Surg 2017; 104: 681–686.10.1016/j.athoracsur.2016.12.032Google Scholar
6. Li, Y, Yin, S, Fang, J, et al. Neurodevelopmental Delay with Critical Congenital Heart Disease is Mainly from Prenatal Injury Not Infant Cardiac Surgery: Current Evidence based on a Meta‐Analysis of Functional Magnetic Resonance Imaging. Chichester, UK, 2015: 639–648.Google Scholar
7. Morton, DP, Ishibashi, AN, Jonas, AR. Neurodevelopmental abnormalities and congenital heart disease: insights into altered brain maturation. Circ Res 2017; 120: 960–977.10.1161/CIRCRESAHA.116.309048Google Scholar
8. Hovels-Gurich, H. Factors influencing neurodevelopment after cardiac surgery during infancy. Front Pediatr 2016; 4: 137.10.3389/fped.2016.00137Google Scholar
9. Claessens, NHP, Kelly, CJ, Counsell, SJ, Benders, MJNL. Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease. Dev Med Child Neurol 2017; 59: 894–902.Google Scholar
10. Lim, JM, Kingdom, T, Saini, B, et al. Cerebral oxygen delivery is reduced in newborns with congenital heart disease. J Thorac Cardiovasc Surg 2016; 152: 1095–1103.10.1016/j.jtcvs.2016.05.027Google Scholar
11. Masoller, N, Sanz-Cortés, M, Crispi, F, et al. Severity of fetal brain abnormalities in congenital heart disease in relation to the main expected pattern of in utero brain blood supply. Fetal Diagn Ther 2016; 39: 269.Google Scholar
12. Nagaraj, UD, Evangelou, IE, Donofrio, MT, et al. Impaired global and regional cerebral perfusion in newborns with complex congenital heart disease. J Pediatr 2015; 167: 1018–1024.10.1016/j.jpeds.2015.08.004Google Scholar
13. Von Rhein, M, Buchmann, A, Hagmann, C, et al. Severe congenital heart defects are associated with global reduction of neonatal brain volumes. J Pediatr 2015; 167: 1259–1263.e1.10.1016/j.jpeds.2015.07.006Google Scholar
14. Khalil, A, Suff, N, Thilaganathan, B, Hurrell, A, Cooper, D, Carvalho, JS. Brain abnormalities and neurodevelopmental delay in congenital heart disease: systematic review and meta‐analysis. Chichester, UK, 2014: 14–24.Google Scholar
15. Owen, M, Shevell, M, Donofrio, M, et al. Brain volume and neurobehavior in newborns with complex congenital heart defects. J Pediatr 2014; 164: 1121–1127.e1.Google Scholar
16. Limperopoulos, C, Majnemer, A, Shevell, MI, Rosenblatt, B, Rohlicek, C, Tchervenkov, C. Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr 2000; 137: 638–645.Google Scholar
17. Faraoni, GD, Vo, AD, Nasr, AV, Dinardo, AJ. Development and validation of a risk stratification score for children with congenital heart disease undergoing noncardiac surgery. Anesth Analg 2016; 123: 824–830.10.1213/ANE.0000000000001500Google Scholar
18. Gunn, JK, Beca, J, Hunt, RW, et al. Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy. Arch Dis Child 2016; 101: 1010.10.1136/archdischild-2015-309449Google Scholar
19. Calderon, J, Stopp, C, Wypij, D, et al. Early-term birth in single-ventricle congenital heart disease after the fontan procedure: neurodevelopmental and psychiatric outcomes. J Pediatr 2016; 179: 96–103.10.1016/j.jpeds.2016.08.084Google Scholar
20. Gaynor, JW, Stopp, C, Wypij, D, et al. Impact of operative and postoperative factors on neurodevelopmental outcomes after cardiac operations. Ann Thorac Surg 2016; 102: 843–849.10.1016/j.athoracsur.2016.05.081Google Scholar
21. Sananes, R, Manlhiot, C, Kelly, E, et al. Neurodevelopmental outcomes after open heart operations before 3 months of age. Ann Thorac Surg 2012; 93: 1577–1583.Google Scholar
22. Newburger, WJ, Sleeper, AL, Bellinger, CD, et al. Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation 2012; 125: 2081–2091.Google Scholar
23. Gaynor, J, Stopp, C, Wypij, D, et al. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 2015; 135: 816–825.10.1542/peds.2014-3825Google Scholar
24. Bellinger, DC, Watson, CG, Rivkin, MJ, et al. Neuropsychological status and structural brain imaging in adolescents with single ventricle who underwent the Fontan procedure. J Am Heart Assoc 2015; 4: e002302.10.1161/JAHA.115.002302Google Scholar
25. Massaro, AN, Glass, P, Brown, J, et al. Neurobehavioral abnormalities in newborns with congenital heart disease requiring open-heart surgery. J Pediatr 2011; 158: 678–681.e2.10.1016/j.jpeds.2010.11.060Google Scholar
26. Lisanti, AJ, Cribben, J, Connock, EM, Lessen, R, Medoff-Cooper, B. Developmental care rounds. An interdisciplinary approach to support developmentally appropriate care of infants born with complex congenital heart disease. Clin Perinatol 2016; 43: 147–156.Google Scholar
27. Einspieler, C, Prechtl, HRF, Bos, A, et al. Prechtl’s Method on the Qualitative Assessment of General Movements in Preterm, Term and Young Infants. Mac Keith Press, Cambridge London, New York/London; Distributed by Cambridge University Press, New York, 2004.Google Scholar
28. Campbell, SK. The Test of Infant Motor Performance v5.0. Test User’s Manual Version 3.0. Infant Motor Performance Scales, LLC, Chicago, 2012.Google Scholar
29. Einspieler, C, Marschik, P, Bos, A, Ferrari, F, Cioni, G, Prechtl, HF. Early Markers for Cerebral Palsy: Insights from the Assessment of General Movements. Future Medicine Ltd, London, 2012: 709–717.Google Scholar
30. Noble, Y, Boyd, R. Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review. Dev Med Child Neurol 2012; 54: 129–139.Google Scholar
31. Spittle, AJ, Doyle, LW, Boyd, RN. A systematic review of the clinimetric properties of neuromotor assessments for preterm infants during the first year of life. Dev Med Child Neurol 2008; 50: 254–266.10.1111/j.1469-8749.2008.02025.xGoogle Scholar
32. Bosanquet, M, Copeland, L, Ware, R, Boyd, R. A systematic review of tests to predict cerebral palsy in young children. Dev Med Child Neurol 2013; 55: 418–426.Google Scholar
33. Einspieler, C, Bos, AF, Libertus, ME, Marschik, PB. The general movement assessment helps us to identify preterm infants at risk for cognitive dysfunction. Front Psychol 2016; 7: 406.10.3389/fpsyg.2016.00406Google Scholar
34. Campbell, KS, Zawacki, ML, Rankin, CK, et al. Concurrent validity of the TIMP and the Bayley III scales at 6 weeks corrected age. Pediatr Phys Ther 2013; 25: 395–401.Google Scholar
35. Squires, J, Bricker, D. Ages & Stages Questionnaires, Third Edition (ASQ-3): A Parent-Completed Child Monitoring System. Brookes Publishing Co., Baltimore, MD, 2009.Google Scholar
36. Mussatto, KA, Hoffmann, RG, Hoffman, GM, et al. Risk and prevalence of developmental delay in young children with congenital heart disease. Pediatrics 2014; 133: e570.Google Scholar
37. Noeder, MM, Logan, BA, Struemph, KL, et al. Developmental screening in children with CHD: ages and stages questionnaires. Cardiol Young 2017; 27: 1447–1454.Google Scholar
38. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardio-Thorac Surg 2004; 25: 911–924.10.1016/j.ejcts.2004.03.027Google Scholar
39. Lacour-Gayet, RF, Clarke, RD. The Aristotle method: a new concept to evaluate quality of care based on complexity. Curr Opin Pediatr 2005; 17: 412–417.10.1097/01.mop.0000165361.05587.b9Google Scholar
40. StataCorp. Stata Statistical Software: Release 13. StataCorp LP, College Station, TX, 2013.Google Scholar
41. Campbell, M, Rabbidge, B, Ziviani, J, Sakzewski, L. Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery. J Paediatr Child Health 2017; 53: 794–799.Google Scholar
42. Long, SH, Harris, SR, Eldridge, BJ, Galea, MP. Gross motor development is delayed following early cardiac surgery. Cardiol Young 2012; 22: 574–582.Google Scholar
43. Mackie, AS, Alton, GY, Dinu, IA, et al. Clinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery. J Thorac Cardiovasc Surg 2012; 145(5): 1248–1254.10.1016/j.jtcvs.2012.04.029Google Scholar
44. Crowle, C, Walker, K, Galea, C, Novak, I, Badawi, N. General movement trajectories and neurodevelopment at 3 months of age following neonatal surgery. Early Hum Dev 2017; 111: 42–48.10.1016/j.earlhumdev.2017.05.010Google Scholar
45. Moody, C, Callahan, TJ, Aldrich, H, Gance-Cleveland, B, Sables-Baus, S. Early initiation of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) reduces length of stay: a quality improvement project. J Pediatr Nurs 2017; 32: 59–63.10.1016/j.pedn.2016.11.001Google Scholar
46. Als, H, Duffy, FH, Mcanulty, G, et al. NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction. J Perinatol 2012; 32: 797.10.1038/jp.2011.201Google Scholar
47. Butler, SC, Huyler, K, Kaza, A, Rachwal, C. Filling a significant gap in the cardiac ICU: implementation of individualised developmental care. Cardiol Young 2017; 27: 1797–1806.Google Scholar
48. Sood, ME, Berends, LW, Butcher, JJ, et al. Developmental care in North American pediatric cardiac intensive care units: survey of current practices. Adv Neonatal Care 2016; 16: 211–219.Google Scholar
49. Latal, B. Neurodevelopmental outcomes of the child with congenital heart disease. Clin Perinatol 2016; 43: 173–185.10.1016/j.clp.2015.11.012Google Scholar
50. Pike, N, Pemberton, V, Allen, K, et al. Challenges and successes of recruitment in the “angiotensin-converting enzyme inhibition in infants with single ventricle trial” of the Pediatric Heart Network. Cardiol Young 2013; 23: 248–257.10.1017/S1047951112000832Google Scholar
51. Crowle, C, Badawi, N, Walker, K, Novak, I. General movements assessment of infants in the neonatal intensive care unit following surgery. J Paediatr Child Health 2015; 51: 1007–1011.10.1111/jpc.12886Google Scholar
52. Piper, MC, Darrah, J. Motor Assessment of the Developing Infant. W. B. Saunders, Philadelphia, 1994.Google Scholar
53. Heineman, KR, Bos, AF, Hadders-Algra, M. The infant motor profile: a standardized and qualitative method to assess motor behaviour in infancy. Dev Med Child Neurol 2008; 50: 275–282.Google Scholar
54. Michael, M, Scharf, R, Letzkus, L, Vergales, J. Improving neurodevelopmental surveillance and follow‐up in infants with congenital heart disease. Congenit Heart Dis 2016; 11: 183–188.10.1111/chd.12333Google Scholar