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Functional limitations in young children with congenital heart defects after cardiac surgery
C Limperopoulos1, A Majnemer, M I Shevell
1School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada.
Insights
Infants undergoing open-heart surgery often experience significant functional limitations and daily living skill deficits. These neurodevelopmental sequelae impact socialization and require greater clinical attention.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Pediatric Surgery
Background:
- Infant mortality rates after open-heart surgery (OHS) have declined significantly.
- Concerns are rising regarding neurodevelopmental sequelae in infants post-OHS.
- Previous studies focused on developmental impairments, neglecting functional outcomes and family burden.
Purpose of the Study:
- To determine the prevalence of functional limitations in young children with congenital heart defects (CHD) after OHS.
- To investigate the burden of care associated with these functional limitations.
- To identify risk factors for functional disabilities post-OHS.
Main Methods:
- Prospective recruitment of 131 infants with CHD undergoing their first OHS.
- Preoperative, postoperative, and 12-18 month postoperative functional assessments.
- Utilized the WeeFIM (Functional Independence Measure) and Vineland Adaptive Behavior Scale.
Main Results:
- Only 21% of children functioned within the expected age range.
- 37% had moderate disability, 6% severe disability (WeeFIM).
- 40% had daily living skill difficulties, over 50% had poor socialization skills (Vineland).
Conclusions:
- High prevalence of functional limitations and dependence in daily living is underappreciated.
- Pediatricians and developmental specialists should give these outcomes more attention.
- Risk factors include perioperative neurodevelopment, microcephaly, circulatory arrest duration, ICU stay, age at surgery, and maternal education.
Unlabelled:
With the recent dramatic decline in mortality rates of infants undergoing open-heart surgery (OHS), there is growing concern regarding neurodevelopmental sequelae. Outcome studies have primarily focused on delineating developmental impairments; however, the impact on function and family burden has not been investigated. The objective of this study was to determine the prevalence of functional limitations and burden of care of young children with congenital heart defects (CHD) after OHS.
Study Design:
One hundred thirty-one eligible infants with CHD undergoing their first OHS were recruited prospectively. Patients were assessed pre- and postoperatively, and again 12 to 18 months after surgery. Functional assessments included the WeeFIM (Functional Independence Measure) and the Vineland Adaptive Behavior Scale.
Results:
For the WeeFIM, mean quotients were 84.3 +/- 23.8 (self-care), 77.2 +/- 30.0 (mobility), and 92.4 +/- 27.8 (cognition), with an overall quotient of 83.8 +/- 23.4. Only 21% of the cohort was functioning within their expected age range. Moderate disability was noted in 37%, while only 6% demonstrated a severe disability. For the Vineland scale, mean score for daily living skills was 84.4 +/- 17.6, and 80.3 +/- 15.9 for socialization. Functional difficulties in daily living skills were documented in 40%, whereas >1/2 had poor socialization skills. Factors enhancing risk for functional disabilities included perioperative neurodevelopmental status, microcephaly, length of deep hypothermic circulatory arrest, length of stay in the intensive care unit, age at surgery, and maternal education.
Conclusions:
The high prevalence of functional limitations and dependence in activities of daily living is currently underappreciated in the clinical setting, and deserves additional attention by pediatricians and developmental specialists.