Infants With Congenital Heart Defects Have Motor Impairment Risk

By Lisa Rapaport

November 19, 2020

(Reuters Health) - Infants born with congenital heart defects requiring open heart surgery have an increased risk of motor impairments throughout childhood and adolescence, a systematic review suggests.

Researchers examined data from 46 studies published between 1997 and 2019 that focused on fine or gross motor skills in children who had open heart surgery for congenital heart defects. Across all the studies, overall prevalence of motor impairments ranged from 12.3% to 68.6% and prevalence of severe motor impairments ranged from 0% to 60%.

"Prenatally and early in life, these children are at high-risk for recurring exposure to hypoxic-ischemic insults to the immature brain," said senior study author Marie Brossard-Racine, an assistant professor in the School of Physical and Occupational Therapy at McGill University in Montreal.

"The motor impairments observed in children with complex congenital heart defects are likely multifactorial, and the result of a combination of missing age-appropriate experiences and delayed underlying brain neurodevelopment," Brossard-Racine said by email.

Among toddlers 1 to 3 years old, overall prevalence of motor impairments ranged from 12.3% to 59% and prevalence of severe motor impairments ranged from 1.5% to 60%.

For children 3 to 6 years old, overall prevalence of motor impairments ranged from 32.4% to 68.6% and prevalence of severe motor impairments ranged from 7.7% to 28.6%.

For school-age kids from 6 to 13 years, overall prevalence of motor impairments ranged from 26.7% to 46.1% and prevalence of severe motor impairments ranged from 7.5% to 25.8%.

Just one study looked at motor impairments in adolescence. This study found that for youth 13 to 19 years old, the overall prevalence of motor impairments was 42.4% and the prevalence of severe motor impairments was 18.2%.

When researchers looked at the magnitude of impairment, the effect size of differences in fine and gross motor skills between children with congenital heart defects and typically developing children ranged from -0.07 to 2.19, based on an analysis of 38 studies with this measurement.

The studies included in the analysis were done on five continents. A total of 16 studies (35%) were conducted in the U.S., while 7 (15%) were done in Canada, 6 (13%) were done in Germany, and 4 (9%) were done in Australia.

Children in the studies had various types of congenital heart defects including aortic arch obstruction, hypoplastic left heart syndrome or other forms of single ventricle defects, total anomalous pulmonary venous connection, transposition of the great arteries, and ventricular septal defect.

There were 14 studies (30%) included in the analysis that appeared to have a low risk of bias based on several criteria, such as performance bias and attrition bias.

One limitation of the systematic review is the varied sampling and methodology in the smaller studies included in the analysis. In particular, different motor evaluation tools may have contributed to variation in the results, the study team notes in Pediatrics.

"Of course it is possible that a prolonged movement restriction and, more so, severe illness itself can lead to a delay in motor activity and milestones, but this is usually temporary and children without any brain alteration will catch-up this delay very quickly," said Dr. Beatrice Latal, a professor at the Child Development Center at University Children's Hospital Zurich in Switzerland who wasn't involved in the study.

Children with a complex heart disease requiring cardiac surgery should be followed by a specialized multidisciplinary team as part of a follow-up program to ensure early detection of developmental impairments, timely therapeutic interventions, and parental counseling, Dr. Latal said by email.

"If this is not in place, health care providers need to carefully monitor the developmental progress of a child who underwent cardiac surgery and should refer her or him to a specialist for detailed developmental assessment and start of therapies if indicated," Dr. Latal advised.

SOURCE: https://bit.ly/38YKrnl Pediatrics, online November 18, 2020.

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