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Inpatient Screening for Early Identification of Developmental Risk in Infants with Congenital Heart Defects
Samantha C Butler1, Valerie Rofeberg2, David Wypij3
1Department of Psychiatry and Behavioral Services, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
Insights
An inpatient developmental screener effectively identifies infants with congenital heart defects (CHD) at risk for developmental delays. This early identification facilitates timely interventions and overcomes barriers to post-discharge follow-up assessments.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Clinical Pediatrics
Background:
- Infants with congenital heart defects (CHD) are at increased risk for neurodevelopmental challenges.
- Early identification of developmental risks is crucial for timely intervention and improved outcomes.
- Standardized screening tools administered during inpatient stays can aid in early detection.
Purpose of the Study:
- To evaluate the effectiveness of an inpatient standardized developmental screener for identifying infants with CHD who are at risk for developmental delays.
- To assess the clinical utility of the Bayley Scales of Infant and Toddler Development Screening Test, Third Edition (Bayley-III Screener) in a postoperative CHD population.
Main Methods:
- A retrospective, observational study involving 325 postoperative infants with CHD (3-12 months old) who received the Bayley-III Screener before discharge.
- Follow-up neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) was conducted in 74 infants (23% follow-up rate) between 12-42 months of age.
Main Results:
- A significant proportion of infants scored below age expectations in Gross Motor (79%), Fine Motor (63%), Receptive Communication (50%), Expressive Communication (38%), and Cognitive (38%) domains.
- Infants with CHD demonstrated higher rates of scores below expectations compared to normative samples (P < .001).
- Higher risk category scores on the Bayley-III Screener predicted worse performance on the outpatient Bayley-III (P < .01), with increased odds associated with genetic syndromes and longer hospital stays.
Conclusions:
- Inpatient standardized neurodevelopmental screening is clinically valuable for identifying infants at risk for developmental concerns.
- This screening facilitates recommendations for developmental services and potentially mitigates barriers to outpatient follow-up assessments.
- The Bayley-III Screener demonstrates utility in early risk identification for infants with CHD, enabling prompt intervention planning.
Objective:
To assess the utility of an inpatient standardized developmental screener for early identification of developmental risk in infants with a congenital heart defect (CHD).
Study Design:
This was a retrospective, observational study with convenience sample of postoperative infants with CHD (aged 3-12 months) who underwent neurodevelopmental screening with the Bayley Scales of Infant and Toddler Development Screening Test, Third Edition (Bayley-III Screener) just before discharge. Follow-up testing included outpatient Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) (12-42 mo).
Results:
The Bayley-III Screener was administered to 325 infants at a median of 5 months, 8 days (IQR 3 months, 28 days, to 7 months, 17 days). Infants scored below age expectations on the Gross Motor (79%), Fine Motor (63%), Receptive Communication (50%), Expressive Communication (38%), and Cognitive (38%) domains. In each domain, children with CHD had greater rates of scores below expectations than the normative sample (each P <.001). The odds of scoring in a greater risk category were increased for infants with genetic syndromes and longer length of hospital stay across all domains. The outpatient Bayley-III (n = 74, 23% follow-up) was completed at a median of 19 months, 9 days (IQR: 17 months, 3 days, to 23 months, 37 days). Individuals falling in greater-risk categories on their initial Bayley-III Screener were significantly more likely to have worse performance on their follow-up outpatient Bayley-III (each domain P < .01).
Conclusions:
Inpatient standardized neurodevelopmental screening provides important clinical utility in identifying infants at risk for developmental concern, allows for provision of recommendations for developmental services, and potentially overcomes barriers often noted in returning for outpatient post-discharge assessments.
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