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Hand Grip Strength at 4.5 Years of Age After Complex Cardiac Surgery in Early Infancy
Fernanda de Marzio Pestana Martins1, Ari R Joffe2,3, Paul Calistrate-Petre4
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta, 4-546 Edmonton Clinic Health Academy, 11405 112 Street, Edmonton, AB, T6G 1C9, Canada.
Insights
Hand grip strength (HGS) in children post-infancy cardiac surgery showed lower scores linked to being small for gestational age and higher lactate levels. HGS assessment feasibility was limited in this population.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Surgical Outcomes
Background:
- Hand grip strength (HGS) is a key indicator of muscle function and overall health.
- Complex cardiac surgery in infancy can impact long-term child development.
- Understanding HGS and its predictors in this cohort is crucial for assessing recovery and potential interventions.
Purpose of the Study:
- To determine hand grip strength (HGS) in young children following complex cardiac surgery in early infancy.
- To identify predictors of HGS in this specific pediatric population.
- To assess the feasibility of HGS measurement at 4.5 years of age.
Main Methods:
- A prospective inception-cohort study included children who underwent complex cardiac surgery between 2010-2019.
- Hand grip strength (HGS) was measured using the Martin Vigorimeter at 4.5 years of age.
- Univariate and multiple linear regression models analyzed associations between HGS and predictor variables (demographics, illness severity, outcomes).
Main Results:
- HGS assessment was completed by 42% of survivors; those not assessed had higher illness severity.
- Lower HGS z-scores were associated with being small for gestational age.
- Higher HGS z-scores correlated with higher full-scale intelligence quotient and height z-scores.
- Elevated lactate levels post-surgery were linked to lower HGS z-scores.
Conclusions:
- HGS measurement feasibility is limited in 4.5-year-olds post-infancy complex cardiac surgery.
- Factors like small for gestational age and perioperative lactate may be modifiable targets to improve HGS.
- Further research is needed to optimize HGS assessment and interventions in this population.
Abstract:
Hand grip strength (HGS) is a validated measure of muscle function. We aimed to determine HGS and its predictors in young children after complex cardiac surgery in early infancy. A prospective inception-cohort of children who had complex cardiac surgery in early infancy between 2010-2019 had HGS measured using the Martin Vigorimeter at age 4.5 years. Predictor variables (demographics, severity-of-illness perioperatively and at age 4-5 years, and outcomes at 4-5 years of age) association with HGS were determined using univariate and two multiple linear regression models (considering all variables, and excluding distal variables). Of 390 survivors, 165 (42%) completed and 162 (42%) did not complete HGS assessment, and 63 (16%) were lost to follow-up or pending. Children who did not complete HGS had significantly higher illness severity and adverse outcome variables versus children who had HGS assessed. Stronger hand Z-scores for HGS were mean 1.16 (SD 1.72). In model 1, lower HGS z-score was statistically associated with small for gestational age, while higher HGS z-score was statistically associated with full-scale intelligence quotient and height z-score. In model 2, highest lactate after surgery was statistically associated with lower HGS z-score (Effect Size -0.11 (95% CI -0.21, -0.02), p=0.022). HGS measurement was feasible in 42% of survivors, limiting its application at the young age of 4.5 years after having had complex cardiac surgery in infancy. Risk factors including small for gestational age and highest lactate after surgery may be modifiable.
