Motor Impairment in Children With Congenital Heart Defects: A Systematic Review

Abstract

CONTEXT: With improvements in survival rates in newborns with congenital heart defects (CHDs), focus has now shifted toward enhancing neurodevelopmental outcomes across their life span. OBJECTIVE: To systematically review the prevalence and extent of motor difficulties in infants, children, and adolescents with CHD requiring open-heart surgery. DATA SOURCES: Data sources included Embase, Medline and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: Original studies published between 1997 and 2019 examining gross and/or fine motor skills in children born with a CHD requiring open-heart surgery were selected. DATA EXTRACTION: The prevalence of motor impairments and mean scores on standardized motor assessments were extracted. Findings were grouped in 5 categories on the basis of the age of the children. RESULTS: Forty-six original studies were included in this systematic review. The prevalence of mild to severe motor impairments (scores <−1 SD below normative data or controls) across childhood ranged from 12.3% to 68.6%, and prevalence ranged from 0% to 60.0% for severe motor impairments (<−2 SDs). Although our results suggest that the overall prevalence of motor impairments <−1 SD remains rather constant across childhood and adolescence, severe motor impairments (<−2 SDs) appear to be more prevalent in younger children. LIMITATIONS: Variability in sampling and methodology between the reviewed studies is the most important limitation of this review. CONCLUSIONS: The results of this review highlight that infants with CHD have an increased risk of motor impairments across infancy, childhood, and adolescence. These findings stress the importance of systematic screening or evaluation of motor skills across childhood and adolescence in children with CHD.

Canadian Developmental Follow-up Practices in Children With Congenital Heart Defects: A National Environmental Scan

“…Children and adolescents with congenital heart disease (CHD) are at high risk for developmental delays. [1][2][3] These delays can affect various developmental domains, such as cognitive, language, psychosocial, and motor abilities, to different degrees based in part on the complexity of the CHD. [1][2][3][4] Although approximately 10% of children with less complex forms of CHD (eg, atrial septal defect and ventricular septal defect) experience persisting developmental impairments, delays are documented in up to 50% of the children with more complex CHD (eg, tetralogy of Fallot, coarctation of the aorta, transposition of the great arteries, and single functional ventricle).…”

“…[1][2][3] These delays can affect various developmental domains, such as cognitive, language, psychosocial, and motor abilities, to different degrees based in part on the complexity of the CHD. [1][2][3][4] Although approximately 10% of children with less complex forms of CHD (eg, atrial septal defect and ventricular septal defect) experience persisting developmental impairments, delays are documented in up to 50% of the children with more complex CHD (eg, tetralogy of Fallot, coarctation of the aorta, transposition of the great arteries, and single functional ventricle). 4 Some of these developmental challenges will become evident in early childhood, but others, such as impaired executive functions and learning, become apparent only as the child gets older or during adolescence.…”

Microstructural alterations of the corticospinal tract are associated with poor motor function in patients with severe congenital heart disease

“…Previous studies have reported that motor impairments occur in approximately one-third of all patients with CHD across infancy, childhood and adolescence (see systematic review: ( Bolduc et al, 2020 ). Infants with CHD undergoing heart surgery before the age of 6 months show noticeably delayed motor development at the age of one year with an average Psychomotor Development Index of 78 measured with the Bayley Scales of Infant Development II ( Snookes et al, 2010 ).…”

“…However, it has become evident that children with complex CHD requiring open-heart surgery are at increased risk for neurodevelopmental impairments in various developmental domains including cognitive, behavioral and motor function. Delayed motor milestones may already appear in the first year of life ( Latal, 2016 ) and mild to moderate motor impairments often persist across childhood and adolescence ( Bolduc et al, 2020 ).…”

“…In particular, the motor system could serve as a promising model to study the association of anatomical alterations and functional (i.e., motor) outcome in CHD patients, since it is a rather simple functional system, which has frequently been described to be impaired in the CHD population ( Bolduc et al, 2020 , Schaefer et al, 2013 , Snookes et al, 2010 ). However, to date no study has investigated a direct association between neuroanatomic findings and neuromotor outcomes in CHD patients.…”