Cognitive Outcomes and Delirium After Cardiac Neurodevelopmental Program Implementation for Children With Congenital
Kelly R Wolfe1, Reagan Broach2, Caelah Clark2
1Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.
Insights
Implementing the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program reduced delirium and improved cognitive scores in children with congenital heart disease (CHD). These findings highlight the benefits of developmental care interventions for hospitalized pediatric cardiac patients.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Quality Improvement Science
Background:
- American Heart Association advisory highlighted benefits of developmental care for hospitalized children with congenital heart disease (CHD).
- A critical research gap exists in evaluating inpatient developmental care programs' association with neurodevelopmental outcomes in CHD patients.
Purpose of the Study:
- To investigate associations between Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program interventions, delirium, and neurodevelopment in young children (newborn to 2 years) hospitalized with CHD.
Main Methods:
- A cohort study utilizing quality improvement data from inpatient cardiac units at a US tertiary care children's hospital.
- The study included 1019 pediatric patients (0-2 years) admitted for at least 7 days between September 2018 and September 2023.
- The CINCO program, comprising 5 interventions, was implemented in phases starting September 2020. Delirium was measured using the Cornell Assessment of Pediatric Delirium, and neurodevelopment using the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-4).
Main Results:
- The CINCO program implementation was associated with a 54.0% decrease in delirium days between program phases 1 and 2, with individual interventions linked to lower delirium incidence.
- Mean BSID-4 cognitive index scores increased from 81.67 before implementation to 93.92 between phases 1 and 2, with four interventions associated with higher cognitive scores.
- Delirium was associated with lower BSID-4 cognitive scores, but not language or motor scores.
Conclusions:
- Implementation of an inpatient developmental care program (CINCO) in hospitalized children with CHD was associated with reduced delirium and improved cognitive scores.
- The study suggests that pediatric cardiac centers may consider adopting these low-cost, low-risk, and generalizable program interventions.
Importance:
A recent advisory from the American Heart Association delineated the potential benefits of developmental care for hospitalized children with congenital heart disease (CHD) and a critical gap in research evaluating the association of such inpatient programs with neurodevelopmental outcomes.
Objective:
To investigate associations between the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program interventions, delirium, and neurodevelopment in young children (newborn through age 2 years) hospitalized with CHD.
Design, Setting, And Participants:
This cohort study used quality improvement data from inpatient cardiac units at a tertiary care children's hospital in the US. Participants were children aged 0 to 2 years who were admitted for at least 7 days from September 1, 2018, to September 1, 2023. The CINCO program was implemented on September 1, 2020, in 6-month plan-do-study-act phases.
Exposures:
The 5 CINCO interventions were medical and/or nursing order panels, developmental kits, bedside developmental plans, caregiver mental health support handouts, and developmental care rounds.
Main Outcomes And Measures:
Number of days with delirium per patient, which was measured using the Cornell Assessment of Pediatric Delirium (a score higher than 9 indicated delirium). Neurodevelopment was measured using the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-4).
Results:
The full sample included 1331 qualifying admissions for 1019 unique pediatric patients (median [range] age at admission, 3.65 [0-34.62] months; 771 males [57.9%]), with a subcohort of 121 unique patients (median [range] age at admission, 0.00 [0-9.85] months; 77 males [63.6%]) whose initial hospitalization occurred before age 10 months and who underwent BSID-4 evaluation at age 12 months or older. The mean (SD) number of days with delirium per patient was stable for 2 years prior to CINCO implementation, decreased by 54.0% between phases 1 and 2 of the CINCO program (from 3.05 [0.60] to 1.38 [0.21]), and then remained stable over time. Each of the 5 CINCO interventions was associated with lower delirium after false discovery rate (FDR) correction (eg, medical and/or nursing order panel: B = -1.376 [95% CI, -1.767 to -0.986]; F2,1273 = 47.767; partial η2 = 0.036; P < .001). Mean (SD) BSID-4 cognitive index scores were stable for 2 years prior to implementation, higher between phases 1 and 2 of the program (from 81.67 [14.14] to 93.92 [19.43]), and then remained stable over time. Four of the 5 interventions were associated with higher BSID-4 cognitive scores after FDR correction (eg, bedside developmental plans: B = 8.585 [95% CI, 2.247-14.923]; F5, 101 = 7.221; partial η2 = 0.067; P = .008). Delirium was associated with lower BSID-4 cognitive scores. There were no associations between delirium and BSID-4 language or motor scores.
Conclusions And Relevance:
This cohort study found that among hospitalized children with CHD, the implementation of an inpatient developmental care program was associated with reduced incidence of delirium and higher cognitive scores. Pediatric cardiac centers may consider adopting these low-cost, low-risk, generalizable program interventions.
