The clinical feasibility of pre operative neurological and neuromotor assessment in infants undergoing open heart surgery

Abstract

Introduction: Infants with congenital heart disease (CHD) who undergo open-heart surgery are at high risk for long-term neurodevelopmental delay. Neurodevelopmental impairments can lead to an increased burden on families, health care systems and educational facilities. Conducting pre-operative assessment allows for early identification of at risk infants and implementation of early intervention. Challenges undertaking pre-operative neurodevelopmental assessments have been reported, limiting the extent to which the impact of surgery can be estimated. This study aims to investigate factors impacting the clinical feasibility of preoperative assessment in infants undergoing open-heart surgery before four months of age. Methods: Infants with CHD who underwent open-heart surgery before four months of age participated in this prospective cohort study. The Test of Infant Motor Performance (TIMP) and Prechtl's Assessment of General Movements (GMs) were undertaken pre- and post-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores, which measure complexity of surgical procedures, were compared between groups of infants who did or did not undergo assessment. Associations were explored using binary logistic regression. Results: Sixty infants were recruited to the study.Median gestational age was 38.78 weeks (IQR 36.93-39.72). Of these infants, 37 (62%) were unable to undergo preoperative assessment due to infant (40%) and environmental (22%) related factors. For every point increase in the Aristotle Patient Adjusted Complexity (APAC) score, the infants likelihood of being able to undergo pre-operative assessment decreased by 35% (OR: 0.35; 95% CI: 1.03-1.77, p=0.03). Discussion: Over half the participants were unable to undergo preoperative assessment, primarily due to infant related medical instability. This study highlights the fragility of this cohort and the limitations associated with administering neurodevelopmental assessments pre-operatively. Further research investigating the APAC score as a potential indicator of children requiring developmental surveillance is warranted.L6200762642018-01-09 <br />