Date Presented 04/05/19
Congenital heart defects (CHD) are the most common congenital defects in newborn infants. Infants with CHD are at higher risk of having motor developmental delays, especially in infants less than six months old. Early identification of delays can lead to early referral for OT and could help in changing the trajectory of the motor delays and improve the quality of life for children with CHD.
Primary Author and Speaker: Turki Aljuhani
Additional Authors and Speakers: Patty Coker-Bolt
Contributing Authors: Dorothea Jenkins, Heather Bonilha
PURPOSE: Congenital heart defects (CHD) are the most common congenital defects in newborn infants. Neurodevelopmental delays are a common complication that infants undergoing cardiac surgery face. Early neurodevelopment delays can result in lifelong complications, if not identified early in life [1].This systematic review was specific to research on motor development in post-surgical CHD infants younger than twelve months of age. We sought to identify any potential or existing variability for delays that prolonged early and accurate identification of neurodevelopment delays.
DESIGN: A Systematic review which examined studies of motor outcomes after cardiac surgery in infant less than one year of age who were diagnosed with CHD.This review was performed according to the PRISMA guidelines for systematic reviews [2]. The review included all randomized control trials, prospective cohort studies or reports of multiple cohorts that met the inclusion criteria for both patients and outcome measures. Case reports and editorials were excluded.
METHOD: Studies that reported infants’ surgical repair or palliation of CHD up to 8 months of age were considered. Studies were excluded if they participants were preterm infants or infants with birth asphyxia because these conditions commonly lead to a decline in motor performance. We included studies that reported motor (gross or/and fine motor skills) outcomes using a standardized assessment tool. The results we reported are limited to infants aged 12 months or less. Non-standardized and/or questionnaire methods of evaluating motor outcomes were not included. The search was limited to peer-reviewed articles published in English from 2008 to 2018. A second author validated 15% of the total articles screened during the initial search for reliability. To assess the quality of the selected articles Newcastle-Ottawa Quality Assessment Scale for cohort and case-control studies was used.
RESULTS: Initial search of PubMed and Scopus databases resulted in a total of 58 articles. Of those, 33 articles underwent full text reviews; 16 articles were excluded due to the following observations: the study did not report motor developmental scores, the age of participants was above 12 months, a questionnaire was used for assessment, or the patient was diagnosed with a genetic disorder. A total of 17 studies were identified for inclusion in the review. Five studies provided data regarding motor outcomes of infants before 6 months of age, while 12 studies provided motor outcomes of infants between 6 months and 12 months of age. Fourteen of the 17 studies reported lower motor mean scores, and all studies for infants less than 6 months of age show a significant delay in motor developmental scores. Motor composite scores were lower when compared to the cognitive composite scores in all identified studies.
CONCLUSIONS: This review illustrated that infants with CHD are at higher risk of having motor developmental delays. Additionally, this review revealed the need for pre and post-surgery studies with sensitive assessment tools to determine neurodevelopment outcomes of infants with CHD. Standardized developmental assessments are infrequently used and rarely repeated. Possible reasons for the not using standardized assessments might be the test administration time, lack of reimbursement, unfamiliarity with the available assessment, and the emphasis on infant’s growth and feeding in early life [3,4].
IMPACT STATEMENT: This systemic review display the need for occupational therapy services to identify delays in infants with CHD early on in life this will allow for early referral to intervention services that can result in change in trajectory of the identified delays.
References
1. Donofrio, M. T., & Massaro, A. N. (2010). Impact of congenital heart disease on brain development and neurodevelopmental outcome. Int J Pediatr, 2010. doi:10.1155/2010/359390
2. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med, 151(4), 264-269, w264.
3. Gellasch, P. (2016). Developmental Screening in the Primary Care Setting: A Qualitative Integrative Review for Nurses. J Pediatr Nurs, 31(2), 159-171. doi:10.1016/j.pedn.2015.10.001
4. Coker-Bolt, P., Barbour, A., Moss, H., Tillman, J., Humphries, E., Ward, E., . . . Jenkins, D. (2016). Correlating early motor skills to white matter abnormalities in preterm infants using diffusion tensor imaging. Journal of Pediatric Rehabilitation Medicine, 9(3), 185-193. doi:10.3233/PRM-160380
