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Clarke SL, Milburn NC, Menzies JC, Drury NE. The provision and impact of rehabilitation provided by physiotherapists in children and young people with congenital heart disease following cardiac surgery: a scoping review. Physiotherapy 2024; 122:47-56. [PMID: 38241942 DOI: 10.1016/j.physio.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/27/2023] [Accepted: 09/20/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Children with congenital heart disease (CHD) are at risk of delayed motor development with increased risk for those requiring cardiac surgical intervention. We conducted a scoping review to identify the provision and impact of physiotherapy-delivered rehabilitation in children and young people with CHD following cardiac surgery. METHODS CINAHL, EMBASE, PUBMED, AHMED, EMCARE, Cochrane Database of Systematic Reviews, NHS Evidence databases were searched (2000-2022). Included studies were published in full, in English and reported the use of physiotherapy in CHD (participants 0-18years) post-surgical procedure. Articles were screened by title and abstract and through full-text review with results structured in accordance with the PAGER framework and PRISMA- ScR checklist. RESULTS Seven full text peer reviewed papers published 2014-2021 were identified from 5747 papers screened. Included papers were predominantly non-randomised cohort studies with a sample size of between one and 247. Study participants ranged from eight days to 16 years, with a variety of congenital heart defects and surgical procedures. The provision of physiotherapy varied with a range of rehabilitation formats and physiotherapeutic interventions utilised. Physiotherapy provision appeared to have a positive impact on functional/ developmental outcomes and muscle strength. DISCUSSION Assessing the impact and provision of physiotherapy in CHD post-surgical intervention is challenging based on the published literature, due to small sample sizes, lack of control groups, heterogeneous demographics and variable intervention and formats delivered. Further research is required to identify the optimum format of physiotherapy provision and establish the potential impact of physiotherapy delivered rehabilitation on motor function and development. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Stephanie L Clarke
- Department of Physiotherapy, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steel House Lane, Birmingham B4 6NH, UK.
| | - Natalie C Milburn
- Department of Physiotherapy, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steel House Lane, Birmingham B4 6NH, UK.
| | - Julie C Menzies
- Paediatric Intensive Care, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steel House Lane, Birmingham B4 6NH, UK.
| | - Nigel E Drury
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Steel House Lane, Birmingham B4 6NH, UK; Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Qi R, Liu S, Wang H, He X, Liu W, Huang F, Zhao Y, Yang B, Xu S, Zeng H. Effects of perioperative exercise on cardiorespiratory endurance in children with congenital heart disease in plateau areas after surgical repair. Sci Rep 2023; 13:18088. [PMID: 37872227 PMCID: PMC10593799 DOI: 10.1038/s41598-023-45310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
We aimed to explore the effects of perioperative exercise on cardiorespiratory endurance in children with congenital heart disease (CHD) in plateau areas after surgical repair. Fifty children with CHD in the plateau admitted to our hospital were randomly divided into the exercise and control groups. The exercise group received a perioperative exercise intervention beginning within 24 h postoperatively, while the control group received routine nursing and treatment alone. To assess the 6 min walk distance (6MWD) at baseline and at end of intervention, children participated in a 6-min walk test before cardiac repair and at 1 week after general ward transfer. A subset of children in the study underwent the cardiopulmonary exercise test pre-operatively. The 6MWD of children with CHD at baseline was positively correlated with the peak oxygen uptake pre-operatively. No significant difference was reported in the preoperative baseline data of both groups. The 6MWD of the exercise group was significantly higher than that of the control group. Early exercise therapy after cardiac repair could significantly improve the cardiorespiratory endurance and exercise capacity of children with CHD in plateau areas.
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Affiliation(s)
- Ruixue Qi
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Henan Medical Key Laboratory of Arrhythmia, Zhengzhou, China
| | - Shijie Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Hongjie Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Xingwei He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Wanjun Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Fen Huang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Yujie Zhao
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Henan Medical Key Laboratory of Arrhythmia, Zhengzhou, China
| | - Bin Yang
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Henan Medical Key Laboratory of Arrhythmia, Zhengzhou, China
| | - Shunlin Xu
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 49 North Garden Road, Beijing, 100191, China.
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China.
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China.
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Rogers SC, Malik L, Fogel J, Hamilton B, Huisenga D, Lewis-Wolf C, Mieczkowski D, Peterson JK, Russell S, Schmelzer AC, Smith J, Butler SC. Optimising motor development in the hospitalised infant with CHD: factors contributing to early motor challenges and recommendations for assessment and intervention. Cardiol Young 2023; 33:1800-1812. [PMID: 37727892 DOI: 10.1017/s1047951123003165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists' role in caring for infants with critical CHD in intensive or acute care hospital units. PURPOSE This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed. CONCLUSIONS Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant's overall development.
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Affiliation(s)
- Stefanie C Rogers
- Children's Health Rehabilitation and Therapy Services, Children's Medical Center Dallas, Dallas, TX, USA
| | - Lauren Malik
- Primary Children's Hospital, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | - Anne C Schmelzer
- Duke University Pediatric and Congenital Heart Center, Durham, NC, USA
| | - Jodi Smith
- The Mended Hearts, Inc., Leesburg, GA, USA
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Kaeslin R, Latal B, Mitteregger E. A systematic review of early motor interventions for infants with congenital heart disease and open-heart surgery. Syst Rev 2023; 12:149. [PMID: 37626406 PMCID: PMC10463862 DOI: 10.1186/s13643-023-02320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Motor development delay is the first neurodevelopmental impairment that becomes apparent in infants with congenital heart disease (CHD). Early interventions have addressed high-risk groups like infants born preterm, but little is known about interventions to improve motor outcome in CHD infants at risk of motor delay. The purpose of this review was to systematically review the literature on type and effect of motor intervention applied during the first year of life in infants with CHD following open-heart surgery. METHODS Scoping searches were performed in May 2020 and April 2023 via MEDLINE, Embase, CINAHL, Cochrane, PsycINFO, PEDro, and Scopus. The review included studies published in English from 2015 to 2022. Primary outcome was infants' motor development measured by standardized and non-standardized motor assessments, and if available, infants' language and cognitive development, and any parental quality-of-life assessments as secondary outcomes. The studies' quality was evaluated with a modified Newcastle-Ottawa scale. RESULTS Four papers with low to high methodological quality met inclusion criteria. All studies investigated the influence of early physiotherapy. Four studies involved parents, and three studies used standardized tools to assess motor outcomes. No conclusion can be drawn about any positive effect of early motor interventions. CONCLUSIONS Early motor intervention in CHD infants may improve motor development; however, the few existing studies do not provide clear evidence. Thus, more prospective early intervention studies are needed. TRIAL REGISTRATION PROSPERO CRD42020200981.
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Affiliation(s)
- Rahel Kaeslin
- Child Development Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Elena Mitteregger
- Child Development Center, University Children's Hospital Zurich, 8032, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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Lisanti AJ, Uzark KC, Harrison TM, Peterson JK, Butler SC, Miller TA, Allen KY, Miller SP, Jones CE. Developmental Care for Hospitalized Infants With Complex Congenital Heart Disease: A Science Advisory From the American Heart Association. J Am Heart Assoc 2023; 12:e028489. [PMID: 36648070 PMCID: PMC9973655 DOI: 10.1161/jaha.122.028489] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Developmental disorders, disabilities, and delays are a common outcome for individuals with complex congenital heart disease, yet targeting early factors influencing these conditions after birth and during the neonatal hospitalization for cardiac surgery remains a critical need. The purpose of this science advisory is to (1) describe the burden of developmental disorders, disabilities, and delays for infants with complex congenital heart disease, (2) define the potential health and neurodevelopmental benefits of developmental care for infants with complex congenital heart disease, and (3) identify critical gaps in research aimed at evaluating developmental care interventions to improve neurodevelopmental outcomes in complex congenital heart disease. This call to action targets research scientists, clinicians, policymakers, government agencies, advocacy groups, and health care organization leadership to support funding and hospital-based infrastructure for developmental care in the complex congenital heart disease population. Prioritization of research on and implementation of developmental care interventions in this population should be a major focus in the next decade.
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Mitteregger E, Dirks T, Theiler M, Kretschmar O, Latal B. A family-tailored early motor intervention (EMI-Heart) for infants with complex congenital heart disease: study protocol for a feasibility RCT. Pilot Feasibility Stud 2022; 8:263. [PMID: 36564855 PMCID: PMC9784271 DOI: 10.1186/s40814-022-01220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Children with congenital heart disease (CHD) undergoing open-heart surgery are at risk for developmental impairments with motor delay manifesting first and contributing to parental concerns. Only a few interventional studies aim to improve neuromotor development in infants with CHD with inconclusive results. We thus developed a family-tailored early motor intervention (EMI-Heart), which aims to promote motor development and family well-being in the first year of life after open-heart surgery. The primary aim described in this protocol is to evaluate feasibility of EMI-Heart. The secondary aim is to describe the difference between the intervention and control group in motor outcomes and family well-being at baseline, post-treatment, and follow-up. METHODS This prospective, parallel single-center feasibility randomized controlled trial (RCT) will compare EMI-Heart with standard of care in infants with complex CHD. Sixteen infants and their families, randomly allocated to EMI-Heart or the control group, will participate within the first 5 months of life. Infants assigned to EMI-Heart will receive early motor intervention for 3 months. The intervention's key is to promote infants' postural control to enhance motor development and partnering with parents to encourage family well-being. Feasibility outcomes will be (a) clinical recruitment rate and percentage of families completing EMI-Heart, (b) average duration and number of sessions, and (c) acceptability of EMI-Heart using a parental questionnaire post-treatment, and descriptive acceptability of EMI-Heart to the pediatric physiotherapist. Secondary outcomes of the intervention and control group will be infants' motor outcomes and questionnaires assessing family well-being at 3-5 months (baseline), at 6-8 months (post-treatment), and at 12 months of age (follow-up). We will evaluate feasibility using descriptive statistics. Non-parametric statistical analysis of secondary outcomes will assess differences between the groups at baseline, post-treatment, and follow-up. DISCUSSION This feasibility RCT will provide information about a newly developed family-tailored early motor intervention in infants with complex CHD. The RCT design will provide a foundation for a future large-scale interventional trial for infants with CHD after open-heart surgery. TRIAL REGISTRATION This study protocol (version 1.3, 01.02.2022) was approved by the Cantonal Ethics Commission Zurich (BASEC-Nr. 2019-01,787) and is registered by Clinicaltrials.gov (NCTT04666857).
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Affiliation(s)
- Elena Mitteregger
- grid.412341.10000 0001 0726 4330Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Tineke Dirks
- Paediatric Physiotherapy, Groningen, Netherlands
| | - Manuela Theiler
- Swiss Parents’ Association for the Child With Heart Disease (Elternvereinigung Für das Herzkranke Kind), Aarau, Switzerland
| | - Oliver Kretschmar
- grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Department of Pediatric Cardiology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- grid.412341.10000 0001 0726 4330Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
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Tran NN, Desai J, Votava-Smith JK, Brecht ML, Vanderbilt D, Panigrahy A, Mackintosh L, Brady KM, Peterson BS. Factor Analysis of the Einstein Neonatal Neurobehavioral Assessment Scale in Infants with Congenital Heart Disease and Healthy Controls. J Child Neurol 2022; 37:851-863. [PMID: 35918821 PMCID: PMC9561959 DOI: 10.1177/08830738221115982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Administration of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) can be time-consuming, and items can be highly correlated. We aimed to determine: (1) its factor analytic structure; (2) the validity of the factor structure; and (3) the associations of physiologic measures with factor scores. Methods: A factor analysis reduced 21 ENNAS items into 5 factors in 57 congenital heart disease (CHD) and 35 healthy infants. Multiple linear regressions examined the association of factor scores with group, gestational age, and physiologic variables. Results: 5-factor solution: 1 (Orienting Reflex), 2 (Extensor Axial Tone), 3 (Primitive Reflexes), 4 (Flexor Tone), 5 (Reflexive Tone Around Extremity Joints). Moderate to strong evidence supported: face, discriminant, and construct validity of these factors, with Factor 2 having the strongest. Conclusions: Components of Factor 2 may provide similar information about neonatal development, thus reducing the time for and burden of administration for researchers and clinicians.
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Affiliation(s)
- Nhu N. Tran
- Institute for the Developing Mind, The Saban Research Institute, Children’s Hospital Los Angeles and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, United States of America,Fetal and Neonatal Institute, Division of Neonatology Children's Hospital Los Angeles, Department of Pediatrics and Keck School of Medicine, University of Southern California, Los Angeles, United States of America,Corresponding Author
| | - Jay Desai
- Division of Neurology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Jodie K. Votava-Smith
- Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, Los Angeles, United States of America
| | - Douglas Vanderbilt
- Fetal and Neonatal Institute, Division of Neonatology Children's Hospital Los Angeles, Department of Pediatrics and Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Ashok Panigrahy
- University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, United States of America and Department of Pediatric Radiology, Children’s Hospital Los Angeles, Los Angeles, United States of America
| | - Liza Mackintosh
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Kenneth M. Brady
- Lurie Children's Hospital of Chicago, Anesthesiology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, United States of America
| | - Bradley S. Peterson
- Institute for the Developing Mind, The Saban Research Institute, Children’s Hospital Los Angeles and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, United States of America,Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, United States of America
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Longitudinal Motor-Developmental Outcomes in Infants with a Critical Congenital Heart Defect. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040570. [PMID: 35455614 PMCID: PMC9030601 DOI: 10.3390/children9040570] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022]
Abstract
Infants with critical congenital heart defects (CCHDs) are at increased risk for neurodevelopmental delays. The early identification of motor delays is clinically relevant to prevent or reduce long-term consequences. The current study aims to describe the motor-developmental pathways of infants with a CCHD. Motor development was assessed in 215 infants and toddlers using the Dutch version of the Bayley-III. At 3 months (n = 165), 9 months (n = 188), and 18 months (n = 171) the motor composite scores were 97, 98, and 104, respectively. A motor composite score of ≤−2 SD was only seen in 2.4%, 0%, and 2.3%, respectively, with gross motor deficits being observed more often than fine motor deficits (12% vs. 0% at 18 months). Over 90% of infants who scored average at 9 months still did so at 18 months. The majority of infants with below-average gross motor scores (≤−1) at 9 months still had a below-average or delayed motor score (≤−2 SD) at 18 months. Abnormal gross motor scores (≤−2 SD) increased with age. Infants with single-ventricle physiology performed significantly (p ≤ 0.05) worse on both fine and gross motor skills at 9 and 18 months compared to infants with other CCHDs.
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Stegeman R, Sprong MCA, Breur JMPJ, Groenendaal F, de Vries LS, Haas F, van der Net J, Jansen NJG, Benders MJNL, Claessens NHP. Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury. Dev Med Child Neurol 2022; 64:192-199. [PMID: 34416027 PMCID: PMC9290970 DOI: 10.1111/dmcn.15024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/23/2023]
Abstract
AIM To assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD). METHOD Neonatal brain magnetic resonance imaging was performed after open-heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery. RESULTS Fifty-one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5-11d) and 15 days (IQR 12-21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15-0.86; cerebellum regression coefficient=3.08, 95% CI=1.07-5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47-5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference -0.8SD, 95% CI=-1.5 to -0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy (n=3) was preceded by severe ischaemic brain injury. INTERPRETATION Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.
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Affiliation(s)
- Raymond Stegeman
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Maaike C A Sprong
- Center for Child Development, Exercise and Physical LiteracyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Johannes M P J Breur
- Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Floris Groenendaal
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Linda S de Vries
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Felix Haas
- Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Janjaap van der Net
- Center for Child Development, Exercise and Physical LiteracyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands
| | - Nicolaas J G Jansen
- Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Department of PediatricsUniversity Medical Center GroningenGroningenthe Netherlands
| | - Manon J N L Benders
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Nathalie H P Claessens
- NeonatologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric CardiologyWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Pediatric Intensive CareWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Congenital Cardiothoracic SurgeryWilhelmina Children’s HospitalUniversity Medical Center Utrecht, Utrecht UniversityUtrechtthe Netherlands,Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
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Sprong MCA, Broeders W, van der Net J, Breur JMPJ, de Vries LS, Slieker MG, van Brussel M. Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis. Pediatr Phys Ther 2021; 33:186-197. [PMID: 34618742 DOI: 10.1097/pep.0000000000000827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To systematically review evidence regarding the severity and prevalence of motor development in children with a critical congenital heart defect (CCHD) without underlying genetic anomalies. SUMMARY OF KEY POINTS Twelve percent of all included studies reported abnormal mean motor developmental scores, and 38% reported below average motor scores. Children with single-ventricle physiology, especially those with hypoplastic left heart syndrome, had the highest severity and prevalence of motor delay, particularly at 0 to 12 months. Most included studies did not differentiate between gross and fine motor development, yet gross motor development was more affected. RECOMMENDATIONS FOR CLINICAL PRACTICE We recommend clinicians differentiate between the type of heart defect, fine and gross motor development, and the presence of genetic anomalies. Furthermore, increased knowledge about severity and prevalence will enable clinicians to tailor their interventions to prevent motor development delays in CCHD.
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Affiliation(s)
- Maaike C A Sprong
- Center for Child Development, Exercise and Physical literacy (Mrs/Ms Sprong, Mr Broeders, Dr van Brussel, and Dr van der Net), Pediatric Cardiology (Dr Breur and Dr Slieker), and Department of Neonatology (Dr de Vries), Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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11
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Hu C, Huang S, Wu F, Ding H. MicroRNA-219-5p participates in cyanotic congenital heart disease progression by regulating cardiomyocyte apoptosis. Exp Ther Med 2020; 21:36. [PMID: 33262822 PMCID: PMC7690344 DOI: 10.3892/etm.2020.9468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
MicroRNAs (miRs) play important roles in the protection against and development of congenital heart disease (CHD). However, the role and potential mechanisms of miR-219-5p in cyanotic CHD remains unclear. Reverse transcription-quantitative PCR (RT-qPCR) was used to measure miR-219-5p levels in cyanotic CHD and hypoxia-induced H9C2 cells. Dual luciferase reporter gene assay was used to confirm whether liver receptor homolog-1 (LRH-1) was a direct target of miR-219-5p. miR-219-5p inhibitor and LRH-1-small interfering RNA were transfected into H9C2 cells under hypoxic conditions to investigate the role of miR-219-5p in hypoxia-induced H9C2 cells. Subsequently, cell viability was detected using an MTT assay and cell apoptosis was detected using flow cytometry. In addition, RT-qPCR and western blotting assays were performed to detect the mRNA and protein expression of LRH-1, cyclin D1 and β-catenin, respectively. The data showed that miR-219-5p expression was higher in patients with cyanotic CHD compared with patients with acyanotic CHD gradually increased in H9C2 cells with prolonged hypoxia time. Dual luciferase reporter assay results showed that LRH-1 was a direct target gene of miR-219-5p. Inhibition of miR-219-5p reversed hypoxia-induced cell viability reduction and attenuated hypoxia-induced cell apoptosis. In addition, hypoxia induction inhibited the expression of LRH-1, cyclin D1 and β-catenin, which was reversed by miR-219-5p inhibitor. However, LRH-1 downregulation reversed the miR-219-5p inhibitor enhanced cell viability, decreased cell apoptosis and increased expression of LRH-1, cyclin D1 and β-catenin in hypoxia-treated cardiomyocytes. The present results demonstrated that downregulation of miR-219-5p promoted the expression of the LRH-1/Wnt/β-catenin signaling pathway-associated components, reduced cardiomyocyte apoptosis and increased cell growth under hypoxic conditions. miR-219-5p may be a potential therapeutic target for cyanotic CHD therapy.
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Affiliation(s)
- Chuanxian Hu
- Department of Cardiopulmonary Surgery, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, P.R. China
| | - Su Huang
- Department of Cardiopulmonary Surgery, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, P.R. China
| | - Fafu Wu
- Department of Cardiopulmonary Surgery, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, P.R. China
| | - Hui Ding
- Department of Cardiopulmonary Surgery, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, P.R. China
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Fang A, Allen KY, Marino BS, Brady KM. Neurologic outcomes after heart surgery. Paediatr Anaesth 2019; 29:1086-1093. [PMID: 31532867 DOI: 10.1111/pan.13744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/05/2019] [Accepted: 09/14/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Amy Fang
- Anesthesia, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Kiona Y Allen
- Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Bradley S Marino
- Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Ken M Brady
- Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
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