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Published on: May 5, 2018
Neurological features in infants with congenital heart disease
Samantha C Butler1,2, Anjali Sadhwani1,2, Valerie Rofeberg3
1Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.
Insights
Neurological abnormalities are common in infants with congenital heart disease (CHD) after surgery. Early developmental services and follow-up are crucial for these children.
Area of Science:
- Pediatric Neurology
- Cardiology
- Developmental Pediatrics
Background:
- Congenital heart disease (CHD) affects a significant number of infants.
- Infants with CHD often undergo complex cardiac surgeries early in life.
- Post-surgical neurodevelopmental outcomes in these infants require thorough investigation.
Purpose of the Study:
- To document neurological examination findings in infants with CHD between 5 and 12 months of age.
- To identify predictors associated with abnormal neurological examinations in this population.
- To inform early intervention strategies and developmental follow-up protocols.
Main Methods:
- Retrospective observational study of 127 infants undergoing cardiac surgery before 3 months of age.
- Standardized neurological examinations conducted by a neurologist between 5 and 12 months.
- Multivariate regression analysis to identify predictors of abnormal neurological findings.
Main Results:
- 88% of infants exhibited neurological abnormalities in at least one assessed domain.
- Most common findings included abnormal axial (48%) and extremity (44%) tone, predominantly hypotonia.
- Abnormal examinations correlated with developmental history concerns, genetic conditions, and newborn assessments.
Conclusions:
- Neurological examination abnormalities are prevalent in infants with CHD post-cardiac surgery.
- Medical complications during infancy increase the risk of neurological deficits.
- Structured developmental history and newborn assessments can predict later neurological examination abnormalities.
Aim:
To report neurological examination findings at 5 to 12 months of age in infants with congenital heart disease (CHD) and to identify predictors of abnormal neurological examination.
Method:
This retrospective observational study included infants who required cardiac surgery at less than 3 months of age and underwent a standard neurological examination from a neurologist in the cardiac neurodevelopmental outpatient clinic between age 5 months and 12 months. Predictors for abnormal neurological examination (concerns on structured developmental history, demographic factors, medical history, and newborn neurodevelopmental assessment) were considered for multivariate regression.
Results:
The sample included 127 infants (mean age 7mo 2wks), who underwent first cardiac surgery at 7 days (4-49 interquartile range [IQR]) of age and were seen for a neurological examination in the cardiac neurodevelopmental clinic. Neurological abnormalities were common; 88% of infants had an abnormal neurological examination in at least one domain assessed. The most common abnormalities were abnormal axial (48%) and extremity (44%) tone, mostly hypotonia. Abnormal neurological examination was associated with concerns on the concurrent structured developmental history, genetic condition, extracardiac anomaly, longer length of stay, more than one cardiac surgery, ongoing early intervention services, and abnormalities on newborn neurodevelopmental assessment.
Interpretation:
Neurological examination abnormalities are common in infants with CHD after infant heart surgery, supporting the need for early and ongoing therapeutic developmental services and adherence to American Heart Association recommendations for developmental follow-up for children with CHD. What this paper adds Neurological examination abnormalities are common in infants who undergo open-heart surgery. Medical complications in infancy increase risk for neurological abnormalities. Family-reported concerns on structured developmental history may predict abnormal neurological examination at 5 to 12 months of age. Abnormal newborn neurodevelopmental assessment may predict abnormal neurological examination at 5 to 12 months of age.
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