Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-24T19:58:19.425Z Has data issue: false hasContentIssue false

Evaluation of a “tummy time” intervention to improve motor skills in infants after cardiac surgery

Part of: Surgery

Published online by Cambridge University Press:  27 September 2021

Karen Uzark*
Affiliation:
Department of Cardiac Surgery, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
Cynthia Smith
Affiliation:
Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
Sunkyung Yu
Affiliation:
Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
Ray Lowery
Affiliation:
Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
Christopher Tapley
Affiliation:
Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
Jennifer C. Romano
Affiliation:
Department of Cardiac Surgery, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
Jennifer Butcher
Affiliation:
Department of Pediatrics, University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
*
Author for correspondence: K. Uzark, PhD, CPNP, University of Michigan Mott Children’s Hospital, 1500 East Medical Center Drive, SPC 5202, Ann Arbor, MI 48109-5202, USA. Tel: (734) 615-9748; Fax: (734) 232-3744. E-mail: karenu@med.umich.edu

Abstract

Background:

Infants who require open heart surgery are at increased risk for developmental delays including gross motor impairments which may have implications for later adaptive skills and cognitive performance. We sought to evaluate the feasibility and efficacy of a tummy time intervention to improve motor skill development in infants after cardiac surgery.

Methods:

Infants <4 months of age who underwent cardiac surgery were randomly assigned to tummy time with or without outpatient reinforcement or standard of care prior to hospital discharge. The Alberta Infant Motor Scale (AIMS) was administered to each infant prior to and 3 months after discharge. Groups were compared, and the association between parent-reported tummy time at home and change in motor scores at follow-up was examined.

Results:

Parents of infants (n = 64) who had cardiac surgery at a median age of 5 days were randomly assigned to tummy time instruction (n = 20), tummy time + outpatient reinforcement (n = 21) or standard of care (n = 23). Forty-nine (77%) returned for follow-up. At follow-up, reported daily tummy time was not significantly different between groups (p = 0.17). Fifteen infants had <15 minutes of tummy time daily. Infants who received >15 minutes of tummy time daily had a significantly greater improvement in motor scores than infants with <15 minutes of tummy time daily (p = 0.01).

Conclusion:

In infants following cardiac surgery, <15 minutes of tummy time daily is associated with increased motor skill impairment. Further research is needed to elucidate the best strategies to optimise parental compliance with tummy time recommendations.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This paper was presented in part as a poster at the American Heart Association Scientific Sessions in Philadelphia, PA, November 16–18, 2019.

References

Gaynor, JW, Stopp, C, Wypij, D, et al. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 2015; 135: 816825.CrossRefGoogle ScholarPubMed
Snookes, SH, Gunn, JK, Eldridge, BJ, et al. A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics 2010; 125: e818e827.CrossRefGoogle ScholarPubMed
Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the american heart association. Circulation 2012; 126: 11431172.CrossRefGoogle ScholarPubMed
Uzark, K, Smith, C, Donohue, J, Yu, S, Romano, JC. Infant motor skills after a cardiac operation: the need for developmental monitoring and care. Ann Thorac Surg 2017; 104: 681686.CrossRefGoogle ScholarPubMed
Masten, AS, Cicchetti, D. Developmental cascades. Dev Psychopathol 2010; 22: 491495.CrossRefGoogle ScholarPubMed
Libertus, K, Joh, AS, Needham, A. Motor training at three months affects object exploration 12 months later. Dev Sci 2016; 19: 10581066.CrossRefGoogle ScholarPubMed
Piper, M, Darrah, J. Motor Assessment of the Developing Infant. Saunders, Philadelphia, PA, 1994.Google Scholar
Salls, JS, Silverman, LN, Gatty, CM. The relationship of infant sleep and play positioning to motor milestone achievement. Am J Occup Ther 2002; 56: 577580.CrossRefGoogle ScholarPubMed
American Academy of Pediatrics Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task force on infant sleep position and sudden infant death syndrome. Pediatrics 2000; 105: 650656.CrossRefGoogle Scholar
Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics 2016; 138: e20162940.CrossRefGoogle Scholar
Pediatrics AAP (pamphlet). Back to Sleep, Tummy to Play. American Academy of Pediatrics, Itasca, IL, 2017. https://wwwhealthychildrenorg/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.Google Scholar
Davis, BE, Moon, RY, Sachs, HC, Ottolini, MC. Effects of sleep position on infant motor development. Pediatrics 1998; 102: 11351140.CrossRefGoogle ScholarPubMed
Zachry, AH, Kitzmann, KM. Caregiver awareness of prone play recommendations. Am J Occup Ther 2011; 65: 101105.CrossRefGoogle ScholarPubMed
Ricard, A, Metz, AE. Caregivers’ knowledge, attitudes, and implementation of awake infant prone positioning. J Occup Ther Sch Early Interv 2014; 7: 1628.CrossRefGoogle Scholar
Mendres-Smith, AE, Borrero, JC, Castillo, MI, Davis, BJ, Becraft, JL, Hussey-Gardner, B. Tummy time without the tears: the impact of parent positioning and play. J Appl Behav Anal 2020; 53: 20902107.CrossRefGoogle Scholar
Fineman, LD, LaBrecque, MA, Shih, MC, Curley, MA. Prone positioning can be safely performed in critically ill infants and children. Pediatr Crit Care Med 2006; 7: 413422.CrossRefGoogle ScholarPubMed
Haefner, SM, Bratton, SL, Annich, GM, Bartlett, RH, Custer, JR. Complications of intermittent prone positioning in pediatric patients receiving extracorporeal membrane oxygenation for respiratory failure. Chest 2003; 123: 15891594.CrossRefGoogle ScholarPubMed
Picheansathian, W, Woragidpoonpol, P, Baosoung, C. Positioning of preterm infants for optimal physiological development: a systematic review. JBI Libr Syst Rev 2009; 7: 224259.CrossRefGoogle ScholarPubMed
WHO. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age: summary, 2019. Accessed 2020.Google Scholar
Hewitt, L, Stanley, RM, Okely, AD. Correlates of tummy time in infants aged 0-12 months old: a systematic review. Infant Behav Dev 2017; 49: 310321.CrossRefGoogle ScholarPubMed
Majnemer, A, Barr, RG. Influence of supine sleep positioning on early motor milestone acquisition. Dev Med Child Neurol 2005; 47: 370376. discussion 364.CrossRefGoogle ScholarPubMed
Bjarnason-Wehrens, B, Dordel, S, Schickendantz, S, et al. Motor development in children with congenital cardiac diseases compared to their healthy peers. Cardiol Young 2007; 17: 487498.CrossRefGoogle ScholarPubMed
Wentz, E. Importance of initiating a, tummy time, intervention early in infants with down syndrome. Pediatr Phys Ther 2017; 29: 6875.CrossRefGoogle ScholarPubMed
Felzer-Kim, IT, Erickson, K, Adkins, C, Hauck, JL. Wakeful prone "tummy time" during infancy: How can we help parents? Phys Occup Ther Pediatr 2020; 40: 118. DOI 10.1080/01942638.2020.1742847.CrossRefGoogle ScholarPubMed
Clinton, A, Cruz, G, Patel, Y, et al. Sternal precautions and prone positioing of infants following median sternotomy: a nationwide survey. Pediatr Phys Ther 2020; 32: 339345.CrossRefGoogle Scholar