Infants with complex congenital heart diseases show poor short-term memory in the mobile paradigm at 3 months of age

The Current Status of Neuroprotection in Congenital Heart Disease

Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.

Motor Impairment in Children With Congenital Heart Defects: A Systematic Review

CONTEXT

With improvements in survival rates in newborns with congenital heart defects (CHDs), focus has now shifted toward enhancing neurodevelopmental outcomes across their life span.

OBJECTIVE

To systematically review the prevalence and extent of motor difficulties in infants, children, and adolescents with CHD requiring open-heart surgery.

DATA SOURCES

Data sources included Embase, Medline and the Cumulative Index to Nursing and Allied Health Literature.

STUDY SELECTION

Original studies published between 1997 and 2019 examining gross and/or fine motor skills in children born with a CHD requiring open-heart surgery were selected.

DATA EXTRACTION

The prevalence of motor impairments and mean scores on standardized motor assessments were extracted. Findings were grouped in 5 categories on the basis of the age of the children.

RESULTS

Forty-six original studies were included in this systematic review. The prevalence of mild to severe motor impairments (scores <-1 SD below normative data or controls) across childhood ranged from 12.3% to 68.6%, and prevalence ranged from 0% to 60.0% for severe motor impairments (<-2 SDs). Although our results suggest that the overall prevalence of motor impairments <-1 SD remains rather constant across childhood and adolescence, severe motor impairments (<-2 SDs) appear to be more prevalent in younger children.

LIMITATIONS

Variability in sampling and methodology between the reviewed studies is the most important limitation of this review.

CONCLUSIONS

The results of this review highlight that infants with CHD have an increased risk of motor impairments across infancy, childhood, and adolescence. These findings stress the importance of systematic screening or evaluation of motor skills across childhood and adolescence in children with CHD.

Right Temporal Oscillations of Infants in Relation to Contingent Learning

Contingent learning is an agent for infants to explore the environment, which enhances the maturation of different developmental domains. This paper presents one of the first to investigate neural activities related to contingent learning of infants by analyzing their motor response that could elicit an audio-visual feedback. Three different kinds of motor response of infants were investigated, including unilateral kicks, synchronized kicks, and alternate kicks. Electroencephalographic (EEG) signals of infants were recorded before the motor experiments. Higher theta band power and lower upper beta power at the right temporal lobe of infants predicted a higher ratio of total unilateral kicks and a lower ratio of synchronized kicks at the later acquisition stage of the experiment. As contingent learning could be reflected by specific motor response in relation to the audio-visual stimuli, the results suggested that right temporal oscillations could predict different levels of contingent learning of infants.

Preliminary evidence of an association between spontaneous kicking and learning in infants between 3-4 months of age

BACKGROUND

The timing and coordination of infant kicking may allow for activities that facilitate learning and cognitive development.

OBJECTIVE

This study examined spontaneous kicking and associations with changes in kicking during a learning paradigm in typically developing infants.

METHODS

Ten healthy full-term infants participated in two experiments at 3 months of age: spontaneous kicking and the mobile paradigm. The inter-limb, intra-limb, and spatiotemporal parameters during spontaneous kicking were collected by 3D motion capture. Learning was measured in the mobile paradigm where an infant's leg was tethered to an overhead mobile. The mobile offered visual and auditory reinforcement when the infant kicked. Changes in kicking rate indicate learning. Friedman tests were used to determine the dominant inter-/intra-limb kicking patterns. Spearman's rank correlation coefficients were used to assess the correlations between spontaneous kicking and performance in the mobile paradigm.

RESULTS

A significant negative correlation (r = -0.72, p = 0.03) was observed between the percentages of unilateral kicking and normalized kicking rate during the extinction phase of the paradigm. There was a trend of positive correlation (r = 0.58, p < 0.10) between dissociated hip-ankle joint coupling and the last three-minute of the acquisition phase of the paradigm.

CONCLUSION

Exploratory kicking behaviors elicited by visual and auditory feedback may be related to lower extremity movement control. Enhancing movement experience through appropriate external feedback may be critical in treatment programs to support infant development. Future studies to assess how exploratory motor behaviors contribute to development in motor and other domains are warranted.

Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors

As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.

A Motor Learning Paradigm Combining Technology and Associative Learning to Assess Prone Motor Learning in Infants

BACKGROUND

Associative learning is the ability to discover a relationship between two or more events. We combined principles of learning and technology to develop a paradigm to assess associative learning in prone.

PURPOSE

The purpose of this study was to determine whether 3- to 6-month-old infants can demonstrate: (1) short-term learning of an association between their upper body movements in prone and activation of a toy, and (2) retention of the association learned on day 1, 24 hours later.

METHODS

Twenty-eight infants who were 3 to 6 months of age and who were typically developing were tested for 2 consecutive days in an instrumented play gym. Both days of testing had a baseline and 4 acquisition phases (2 minutes each). During the acquisition phase, the toy activated for a maximum of 10 seconds when the infant's head was above a threshold. A criterion was set a priori to distinguish infants as short-term learners and retainers of the association learned on day 1.

RESULTS

Of 28 infants, 22 and 14 infants completed all phases of the testing on day 1 and day 2, respectively. Fourteen (50%) of the infants met the criteria for short-term learners. On day 2, there was an analyzable sample of 9 short-term learners. Three of the 12 short-term learners (25%) demonstrated retention on day 2.

CONCLUSION

Consistent with prior infant motor learning research, half of the infants demonstrated associative learning in this novel assessment in prone; however, based on study criteria, the infants had limited retention of the association on day 2.