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Improving Neurodevelopmental Surveillance and Follow-up in Infants with Congenital Heart Disease
Mark Michael1,2, Rebecca Scharf3, Lisa Letzkus3
1Pediatric Cardiology, University of Virginia, Charlottesville, Va, USA.
Insights
Implementing a neurodevelopmental surveillance protocol during cardiac surgery hospitalizations significantly improved patient assessment and follow-up rates for infants with congenital heart disease. This approach enhances care for high-risk children.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Health Services Research
Background:
- Infants with congenital heart disease (CHD) are at increased risk for neurodevelopmental delays.
- Early neurodevelopmental surveillance and timely follow-up are crucial for managing these risks.
- Current surveillance and follow-up rates for at-risk infants with CHD are often suboptimal.
Purpose of the Study:
- To evaluate the effectiveness of a novel protocol for neurodevelopmental surveillance during hospitalization for cardiac surgery in infants under 12 months.
- To assess the impact of this protocol on neurodevelopmental assessment rates and outpatient follow-up compliance.
- To identify patient factors influencing successful screening and follow-up.
Main Methods:
- A protocol was implemented to increase neurodevelopmental surveillance for targeted high-risk infants during their cardiac surgery admission.
- A historical control group from a preceding 6-month period was used for comparison.
- Univariate analysis examined the influence of patient demographics, cardiac anatomy, hospital course, and travel distance on surveillance and follow-up outcomes.
Main Results:
- Neurodevelopmental surveillance rates increased significantly from 21% to 82% post-protocol implementation (P < .001).
- Outpatient follow-up compliance also improved, rising from 38% to 52% (P < .001).
- Younger patients, those with longer intensive care unit and total hospital stays, and those with biventricular hearts were more likely to complete follow-up. Single ventricle anatomy was associated with lower follow-up rates.
Conclusions:
- The implemented protocol effectively enhanced neurodevelopmental surveillance for high-risk infants with CHD.
- Inpatient risk assessment facilitated better neurodevelopmental follow-up, particularly for younger patients and those with longer hospitalizations.
- Modified follow-up schedules may be needed for patients with single ventricle anatomy to improve compliance, as travel distance was not a barrier.
Objective:
We hypothesize that neurodevelopmental surveillance of targeted patients with congenital heart disease during the admission for their cardiac surgery would improve neurodevelopmental assessment and outpatient follow-up rates.
Design:
All patients under 12 months of age who were operated on between October 2013 and October 2014 and were considered at risk for neurodevelopmental delay in accordance with the 2012 American Heart Association Scientific Statement were included. A protocol was implemented to increase surveillance of targeted patients during the hospitalization for their cardiac surgery. A historical control cohort was used from a 6-month period that preceded initiation of the program from July 2012 to December 2012. Univariate analysis assessed the effects of patient demographics, anatomy, postoperative course, and distance from clinic on inpatient screening and follow-up to evaluate areas for future improvement.
Results:
Neurodevelopmental surveillance in the post-protocol period increased from 21% to 82% (P < .001) as did compliance rates for outpatient follow-up from 38% to 52% (P < .001). Patients receiving consultation were younger (median 1.2 months range 0.3-3.1 vs. 4.0 range 1.2-5.5, P = .002), had a longer intensive care unit duration (median 8 days range 4-13 vs. 4 range 3-8, P = .044), and a longer total hospital duration (median 14 days range 8-25 vs. 8 range 6-16, P = .023). The presence of single ventricle anatomy was associated with a lower follow-up rate at 29% than those with biventricular hearts at 64% (P = .009). Distance from the clinic did not have an effect on follow-up (P = .39).
Conclusion:
The protocol described increased neurodevelopmental surveillance of high risk patients. Individuals that were younger and in the hospital longer were more likely to be successfully seen and comply with outpatient follow-up than those not receiving inpatient risk assessment. Patients with single ventricle anatomy may benefit from a modified follow-up schedule to improve compliance rates. Travel distance has no effect on likelihood of outpatient cardiac neurodevelopmental follow-up.
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