Longitudinal Motor-Developmental Outcomes in Infants with a Critical Congenital Heart Defect

Abstract

Infants with critical congenital heart defects (CCHDs) are at increased risk for neurodevelopmental delays. The early identification of motor delays is clinically relevant to prevent or reduce long-term consequences. The current study aims to describe the motor-developmental pathways of infants with a CCHD. Motor development was assessed in 215 infants and toddlers using the Dutch version of the Bayley-III. At 3 months (n = 165), 9 months (n = 188), and 18 months (n = 171) the motor composite scores were 97, 98, and 104, respectively. A motor composite score of ≤−2 SD was only seen in 2.4%, 0%, and 2.3%, respectively, with gross motor deficits being observed more often than fine motor deficits (12% vs. 0% at 18 months). Over 90% of infants who scored average at 9 months still did so at 18 months. The majority of infants with below-average gross motor scores (≤−1) at 9 months still had a below-average or delayed motor score (≤−2 SD) at 18 months. Abnormal gross motor scores (≤−2 SD) increased with age. Infants with single-ventricle physiology performed significantly (p ≤ 0.05) worse on both fine and gross motor skills at 9 and 18 months compared to infants with other CCHDs.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…Last, mean gross motor score for single-ventricle physiology at 18 months was 7.5±3.7 versus 10.6±3.1 for TGA, 10.2±2.8 for TOF, and 9.6±2.6 for aortic arch pathology ( P =0.001). 123…”

Differences in gross motor and fine motor outcomes for toddlers after early complex cardiac surgery

“…7 A few studies have reported lower gross motor than fine motor scores. 3,4,[8][9][10][11][12] Reporting motor standard scores or composite scores without the individual subtest scaled scores masks differences between fine and gross motor scores and thus may decrease the recognition of individual deficits and reduce recommended clinical neurodevelopmental interventions. 8,[11][12][13][14][15] Recognising that long-term motor delays may be improved by early interventions, there is a need to study gross motor and fine motor scores separately to aid clinicians in the care of this population.…”

“…3,4,[8][9][10][11][12] Reporting motor standard scores or composite scores without the individual subtest scaled scores masks differences between fine and gross motor scores and thus may decrease the recognition of individual deficits and reduce recommended clinical neurodevelopmental interventions. 8,[11][12][13][14][15] Recognising that long-term motor delays may be improved by early interventions, there is a need to study gross motor and fine motor scores separately to aid clinicians in the care of this population. [4][5][6]14 Reported acute care predictors of adverse motor outcomes have included a variety of different cardiac defects, especially for those after palliative surgery, imaging determined brain injury, need for anticoagulant medication, longer duration of mechanical ventilation, and longer hospital and intensive care stay.…”

“…[4][5][6]14 Reported acute care predictors of adverse motor outcomes have included a variety of different cardiac defects, especially for those after palliative surgery, imaging determined brain injury, need for anticoagulant medication, longer duration of mechanical ventilation, and longer hospital and intensive care stay. 3,4,8,9,[11][12][13] These previous studies have not considered the predictive role of chronic health conditions for adverse motor development of the children, including chronic health procedures resulting in decreased time in the prone position which is known to be associated with motor delay. 14,15 The failure to report differences in fine and gross motor scores not only can reduce appropriate developmental intervention but also has the clinical effect of preventing the identification of risk factors separately associated with each.…”

Cellphone application rehabilitation management and evaluations of cardiopulmonary function and motor development in infants with congenital heart disease: a pilot study

“…The continued management of the condition is dependent on postoperative care and rehabilitation since the success rate of surgery has significantly increased [ 1 , 2 ]. According to American Heart Association guidelines published in 2012, primary care providers were encouraged to refer CHD children who had undergone cardiac surgery for early developmental evaluation and intervention [ 3 ]. At present, the majority of these programs are designed for children who are preschool or school-aged, and infants with CHD who have undergone surgery but do not yet have access to a standardized cardiac rehabilitation (CR) program; additionally, postoperative CR and evaluation indexes of cardiac function and motor development in the infant population are still unexplored [ 4 ].…”