[Medscape] Newborns with congenital heart defects are at increased risk of motor impairment


A systematic review found that infants with congenital heart defects requiring open-heart surgery were at increased risk of impaired mobility throughout childhood and adolescence.

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. In all studies, the rate of overall mobility impairment ranged from 12.3% to 68.6% and the rate of severe impairment ranged from 0% to 60%.

“Before birth and during the early years of life, these children have high risk of recurrence when in hypoxic ischemia caused damage to the underdeveloped brain.

“The decline in mobility observed in children with complex congenital heart defects may be multifactorial, and is the result of a combination of experiences,” Brossard-Racine said by email. age-appropriate experience and retardation of the brain’s basal nerve development”

In toddlers 1 to 3 years of age, the rate of general decline in mobility ranged from 12.3% to 59% and the rate of severe motor impairment ranged from 1.5% to 1.5%. 60%.

For children aged 3 to 6 years, the overall rate of motor impairment ranged from 32.4% to 68.6% and the rate of severe motor impairment ranged from 7.7% to 28 ,6%.

For school-age children between 6 and 13 years of age, the overall prevalence of mobility impairment ranged from 26.7% to 46.1%, and the rate of severe mobility impairment from 7.5% to 25.8%.

Only one study looked at motor impairment in adolescents. This study found that for adolescents aged 13 to 19 years, the overall rate of mobility impairment was 42.4% and the rate of severe motor impairment was 18.2%.

When the researchers looked at the extent of the impairment, the effect size of differences in gross and fine motor skills between children with congenital heart defects and typical 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 conducted on five continents. A total of 16 studies (35%) were performed in the United States, while 7 (15%) were performed in Canada, 6 (13%) were performed in Germany, and 4 (9%) were performed in the United States. Australia.

Children in the studies had a variety of congenital heart defects including aortic arch obstruction, hypoplastic left heart syndrome or other single ventricular malformations, and total pulmonary venous return abnormalities. , transposition of the great arteries and ventricular septal defect.

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

A limitation of the systematic review is that the sampling and study methods differ among the smaller studies that were also included in the analysis. The Pediatrics team has noted that, in some cases, different motor assessment tools may contribute to varying results.

“Of course it is possible that prolonged exercise restriction, and moreover, the severe disease itself can lead to delays in motor activities and milestones, but this is usually only is temporary and children without any brain changes will catch up to this delay very quickly,” said Dr. Beatrice Latal, professor at the Center for Child Development at the University Children’s Hospital Zurich in Switzerland, who was not involved in the study.

Dr. Latal said by email, children with complex heart conditions requiring heart surgery should be monitored by a multidisciplinary team of experts as part of a follow-up program to ensure early detection of developmental defects, intervention. Timely treatment and counseling for parents.

Dr. Latal advises: “If this is not possible, health care providers should carefully monitor the development of a child who has had heart surgery and should refer the child to a specialist for a detailed evaluation of the condition. development and initiation of therapies if indicated”.

Motor Impairment in Children With Congenital Heart Defects: A Systematic Review
Marie-Eve Bolduc, Eliane Dionne, Isabelle Gagnon, Janet E. Rennick, Annette Majnemer and Marie Brossard-Racine
Pediatrics November 2020, e20200083; DOI: https://doi.org/10.1542/peds.2020-0083

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

Self-translated article, please do not reup.

Source: Medscape

Link: https://www.medscape.com/viewarticle/941231

Author: Roxie Duong

Edit: Duong Ngoc

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