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Differences in gross motor and fine motor outcomes for toddlers after early complex cardiac surgery
Charlene M T Robertson1,2, Sara Khademioureh3, Irina A Dinu3
1Department of Pediatrics, Division of Developmental Pediatrics, University of Alberta, Edmonton, AB, Canada.
Insights
Gross motor skills in toddlers after complex heart surgery are often lower than fine motor skills. Identifying specific predictors for gross motor delays can improve early intervention strategies for these children.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Motor Development
Background:
- Complex cardiac surgery in early childhood can impact neurodevelopmental outcomes.
- Gross and fine motor skills are crucial developmental milestones in toddlers.
- Understanding factors influencing motor development post-cardiac surgery is essential for targeted interventions.
Purpose of the Study:
- To compare gross motor scores with fine motor scores in toddlers following complex cardiac surgery.
- To identify predictors of gross motor versus fine motor scores.
- To determine if composite motor scores adequately represent gross and fine motor abilities.
Main Methods:
- Prospective inception-cohort study of 171 toddlers (<6 months at surgery) without chromosomal abnormalities.
- Motor function assessed using Bayley Scales of Infant and Toddler Development-III at ~21.7 months.
- Multivariate regression analysis to identify predictors for gross and fine motor scores.
Main Results:
- Gross motor scores (7.2 ± 2.7) were lower than fine motor scores (9.4 ± 2.5).
- Predictors for gross motor scores included need for cardiac medication, gastrostomy, and single ventricle physiology.
- These predictors did not significantly influence fine motor scores; 36.9% of variance in gross motor scores was explained.
Conclusions:
- Toddlers undergoing complex cardiac surgery frequently exhibit lower gross motor skills compared to fine motor skills.
- Distinct predictors influence gross motor development, highlighting the need for separate assessment.
- Disaggregated reporting of gross motor scores can enhance the identification of developmental delays and optimize early interventions.
Objectives:
To determine whether gross motor scores of toddlers after complex cardiac surgery were different from fine motor scores and were adequately represented by motor composite scores and, whether acute care predictors and chronic childhood health markers of gross motor scores differed from those of fine motor.
Methods:
This prospective inception-cohort outcomes study included 171 toddlers after complex cardiac surgery with cardiopulmonary bypass at age <6 months, born in Northern Alberta from 2009 to 2019, and without known chromosomal abnormalities. At a mean (standard deviation) age of 21.7 (3.7) months, the Bayley Scales of Infant and Toddler Development-III determined motor composite and scaled scores (normative values, 100 (15), 10 (3), respectively). The same variables from surgery and assessment were analysed using multivariate regression to predict gross and fine motor scores; results expressed as effect size (95% confidence interval) with % variance.
Results:
Composite, fine, and gross motor scores were 89.7 (14.2), 9.4 (2.5), and 7.2 (2.7), respectively. Predictive variables accounted for 21.2% of the variance for fine motor, and 36.9% for gross motor. Multivariate analysis for gross motor scores included toddlers need for cardiac medication, effect size (95% confidence interval) -0.801 (-1.62, -0.02), gastrostomy, -1.35 (-2.39, -0.319), and single ventricle, -0.93 (-1.71, -0.15). These same variables did not predict fine motor scores.
Conclusion:
Gross motor skills commonly were lower than fine motor skills for toddlers after complex cardiac surgery. Predictors for gross motor scores differed from fine motor scores. Separate reporting of gross motor scores could lead to improved identification of predictors of delay and to optimised early intervention.
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