Long-term Neuromotor Outcome at School Entry of Infants with Congenital Heart Defects Requiring Open-heart Surgery

• Published in: The Journal of pediatrics Vol. 148; no. 1; pp. 72 - 77
• Main Authors: Majnemer, Annette, Limperopoulos, Catherine, Shevell, Michael, Rosenblatt, Bernard, Rohlicek, Charles, Tchervenkov, Christo
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 2006; Elsevier
• Subjects: Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Child; Child, Preschool; Cohort Studies; Developmental Disabilities - diagnosis; Developmental Disabilities - etiology; Female; General aspects; Heart Defects, Congenital - surgery; Humans; Infant; Male; Medical sciences; Multivariate Analysis; Muscle Hypotonia - diagnosis; Muscle Hypotonia - etiology; Neurologic Examination; Postoperative Complications - diagnosis; Prospective Studies; Regression Analysis; Schools; Time Factors; ICU; CHD; TGA; Human; Heart; Psychomotor development; Pediatrics; Cardiovascular disease; Infant; Long term; School environment; School; Treatment; Malformation; Surgery; Circulatory system; Congenital cardiopathy
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2005.08.036

Increased survival in infants with complex congenital heart defects (CHDs) has resulted in greater focus on morbidity. This prospective study was conducted to investigate whether or not neuromotor impairments evident acutely persist long-term. A total of 94 infants with CHD were reassessed at school entry (age 64.2 ± 11.3 months) by blinded examiners using the Peabody Developmental Motor Scale and neurologic examination. Neurologic abnormalities were noted in 28.4% of the subjects, with hypotonia and developmental delay most commonly observed. Microcephaly was documented in 15.4% of subjects, with head circumference >50th percentile in only 14.1%. Mean gross and fine motor quotients were shifted downward (82.7 ± 12.3 and 86.2 ± 16.3, respectively), and gross and fine motor delays were prevalent (49.4% and 39.0%, respectively). Severe disability was rare (<5%). Predictors of neurologic impairment included type of surgery (palliative/corrective), abnormal postoperative neurologic examination, and presence of microcephaly at initial surgery. Gross motor delay was more likely if palliated. Deep hypothermic circulatory arrest time, palliative surgery, microcephaly, and number of hospitalizations were associated with fine motor delay. Neurologic impairments and motor delay are common in survivors of open-heart surgery, persisting to age of school entry. Early indicators of medical complications and acute neurologic compromise are associated with increased risk. Early identification and intervention may optimize performance in those at risk.