1. What is the Effect of Infant
Congenital Heart Disease
on Motor Development?
Merna Haridi
Barnard College
Infant Development
Professor Fifer
2. Specific Aims
• To determine whether infant congenital heart disease
(CHD) has an affect on motor development.
• To determine if motor deficits, because of CHD, affect
potential cognitive deficits.
3. Hypothesis
• Infants with more severe cases of CHD will
have more severe motor deficits in motor
development.
• Infants with motor deficits will show
cognitive deficits
4. Background and Significance
Statistics
CHD affects nearly 1% of births per year in the United States
(40,000 infants)
Overall, 85-90% of infants born with CHD are expected to survive to age
18; Nearly half 48% of the deaths due to CHD occurred during infancy
Database: 20,636 people with CHD underwent the cardiovascular
surgery in 2012, where 55% of them were newborns or infants and the
remaining were children between the ages of 1 and 18 years (Hoffman).
5. Background and Significance
Research in relation to Motor Development
• Children with severe cases of CHD displayed motor deficits.
• One research focused on risk factors associated with motor
delays and musculoskeletal impairments in infants with CHD
2 Clinical Cases
• Early intervention teams followed hospital course and parents’
concerns.
• One case: Karim (2 month old infant); motor assessment showed
that he performed below the normal percentile and had an overall
low muscle tone (Long, Eldridge, Galea, & Hariss, 2011).
6. Background and Significance
Research in relation to Cognition
• Study looked into Neurodevelopmental Outcomes in children
with specific types of CHD.
• 133 infants who had a Fontan Surgery were evaluated
(between years 1973-1991). 128 of them underwent
cognitive testing and the mean full scale IQ of 96 was
lower than the population mean. Mental retardation was
found in 8% of the population (Wernovsky et al., 2000).
7. Research Design and Methods
3 Groups: No CHD, Mild CHD, Severe CHD
Sample Size: 900 infants (300 each group)
Target Population: random sample
Method: Echocardiography on fetus (18-41 weeks)
After birth: Tracking infants at 6, 12, & 15 months (Bayley Scales
of Infant Development); Growth measurements.
Analysis: How motor and cognition, using Bayley Scales, is affected
through age groups. Done by looking for correlations across the
measures using Multiple Regression.
Exclusions: children with syndromes/ chromosomal defects;
mothers who smoke/ drug abuse; mothers diagnosed with
anxiety/depression
8. Predicted Results
• Infants with mild & severe cases of CHD will have
delayed motor development at 6,12, and 15 months.
• Those with motor deficits will show cognitive
deficits. The more severe cases will show more
severe cognitive deficits
9. Future Directions
• Findings from this research could put us in a position to
prolong the lives of children with congenital heart disease,
due to improvements in therapeutic standards.
• Improving the quality of life of these infants for when they
encounter challenges in everyday life in adulthood.
10. References
1. Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI. Executive
Summary: The Society of Thoracic Suregeons Congenital Heart Surgery Database
- Fourteenth Harvest—(January 1, 2007-December 31, 2010). Durham, North
Carolina: The Society of Thoracic Surgeons (STS) and Duke Clinical Research
Institute (DCRI), Duke University Medical Center, Spring 2011. stats third bullet
point
2. Long, S., Eldridge, B., Galea, M., & Harris, S. (2011). Risk Factors for Gross
Motor Dysfunction in Infants With Congenital Heart Disease. Infants & Young
Children, 24, 246-258. Retrieved November 26, 2014.
3. Wernovsky, G., Stiles, K., Gauvreau, K., Gentles, T., Duplessis, A., Bellinger, D.,
... Newburger, J. (2000). Cognitive Development After the Fontan Operation.
Circulation, 883-889. Retrieved November 26, 2014,
http://www.hindawi.com/journals/ijpedi/2010/359390/
4. Hoffman, J. (n.d.). Incidence of congenital heart disease: I. Postnatal incidence.
Pediatric Cardiology, 103-113. Retrieved November 27, 2014, from
http://www.cdc.gov/ncbddd/heartdefects/data.html
Congenital Heart disease: includes abnormalities in cardiovascular structures that occur before birth; defects occur while fetus is developing in the uterus. They are the most common types of birth defects.
Milestones of motor development; does this lag in motor development have something to do with how poorly they may be at cognitive skills that motor development is tied to this decreased cognitive abilities. Is there something there really affecting how it is that they are learning about their world. Maybe they have 1 and not the other : do have some motor problems but their cognition was just fine OR some may have some have some chd babies with no problem in motor but yet cognition is off. This helps me disassociate the effect of one on the other. Control for their growth too.
- Another important aim of this research idea is to see if motor deficits are related to other problems, and in this case I will be looking into cognitive measurements at the same ages. Maybe these infants with CHD have a motor deficit, but their cognition is just fine OR possibly others with no problem, yet there may be something off about their cognition, based off of the measurements taken.
2nd bullet- survival of infants with CHDs depends on how severe the defect is when it is diagnosed, and how it is treated.
3rd bullet- database from 96 North American surgical congenital heart centers that represent 90% of all congenital heart surgeries
-there are several types of Congenital heart diseases, some more extreme than others. Research has been done with severe cases of congeneital heart defects and it was found that children with more extreme cases of CHD in fact have delayed motor function.
They embedded these concerns into 2 clinical cases of infants with CHD who required surgery.
With each case, they followed a description of their hospital stay and described roles of an early intervention team that followed up with the infant and the family. Along with the parents priorities and concerns. When motor assessments were conducted, results led to the development of individualized therapy plans. 1 case Karim: motor development assessment results showed that he performed below a specific percentile for his age and overall low muscle tone. This concludes that infants with CHD are at risk for developmental motor delays and muscle impairments, especially if it’s associated with a genetic disorder.
Studies have shown that although the vast majority of children with CHD have normal outcomes, as a group they generally show high rates of neurodevelopmental problems which include mild deficits in cognition attention and neuromotor functions.
http://www.cdc.gov/ncbddd/heartdefects/features/heartdefects-keyfindings2010.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860894/
Wernovsky evaluated 133 patients who had a Fontan operation ( which is surgery for those with complex CHD) between the years 1973–91 For 128 patients who underwent cognitive testing, the mean full scale IQ of 96 was lower than the population mean. Mental retardation was found in 8%. ((Children with a single functioning ventricle who underwent surgery found significantly lower performance IQ and lower scores on memory and learning domains.
function
Evaluate the cerebral blood flow in fetus with CHD- that can be documented by Doppler Ultrasound
Related to the cerebral oxygen content and oxygen delivery to the brain, both of which are dependent on cardiac function.
Studies have shown that although the vast majority of children with CHD have normal outcomes, as a group they generally show high rates of neurodevelopmental problems which include mild deficits in cognition attention and neuromotor functions.
Will be following mothers and their children from early pregnancy with repeated assessments
Sample size: 900 babies (300 each group)
Target Population: random sample
3 Groups: Mild CHD, Severe CHD, No CHD
Method: For most women, a basic ultrasound will show that all four chambers of the baby’s heart have developed. However, an OB/GYN may recommend an echocardiogram if previous ultrasounds or tests detected an abnormal heartbeat or other potential heart problems in the unborn baby. (abdominal echocardiography or transvaginal echocardiography on a fetus during gestation period 18-41 weeks).
Measurements:
Developmental history (comparison of infant’s developmental history to appropriate milestones) Looking at developmental milestones for fine motor skills between ages 0-4 months, 4-8 months, 8-12 months. Observing any “red flags” for fine motor development is the focus. Will use the Test of Infant Motor Performance (TIMP) to assess posture and movement for infants under 4 months of age
Neuromotor examination: evaluating active and passive muscle tone, reflexes, gross motor skills
Growth Measurement: Height weight, BMI, head circumference.
-Using Bayley Scales of Infant Development in order to see if they show any cognitive delay and for assessing motor areas (until how many years of age, 1 right? Since my motor measurements are going to be until 12 months.)
-Another cognitive test I DON’T THINK YOU NEED TO DO ANOTHER COG TEST UNLESS YOU WANT TO DO LIKE AN EEG/VPC/DI
Analysis:
-1 way anova- to see significant differences between the 3 groups (control, mild, severe) with motor development
2 way anova- to see an interaction between infants with congenital heart disease and motor deficits on cognition (done after separating infants with motor deficits from those without).
To test whether motor deficits have an impact on cognitive abilities ( will use the group with motor deficits from both mild and severe)
Exclusions: children with syndromes/ chromosomal defects; mothers who smoke/drug abuse; mothers diagnosed with anxiety/depression
-There is a clear connection in the circuitry of the brain between areas controlling fine motor skills and areas controlling cognition.
Infants with CHD will have delayed motor development and delays in cognitive abilities.
Infants with more severe cases of the disease will show a greater delay in motor development, and a greater impact on their cognition, when compared to those with mild cases.
Infants with the disease and delayed in motor development will show a lag in cognitive skills.
Psychological problems may arise during adulthood, which is why detecting any cognitive problems earlier allows for earlier therapy.
