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Passive range of motion exercise to enhance growth in infants following the Norwood procedure: a safety and feasibility trial

  • Linda M. Lambert (a1), Felicia L. Trachtenberg (a2), Victoria L. Pemberton (a3), Janine Wood (a1), Shelley Andreas (a4), Robin Schlosser (a4), Teresa Barnard (a5), Kaitlyn Daniels (a6), Ann T. Harrington (a6), Nicholas Dagincourt (a2), Thomas A. Miller (a7) and for the Pediatric Heart Network Investigators...

Abstract

Objective

The aim of this study was to evaluate the safety and feasibility of a passive range of motion exercise programme for infants with CHD.

Study design

This non-randomised pilot study enrolled 20 neonates following Stage I palliation for single-ventricle physiology. Trained physical therapists administered standardised 15–20-minute passive range of motion protocol, for up to 21 days or until hospital discharge. Safety assessments included vital signs measured before, during, and after the exercise as well as adverse events recorded through the pre-Stage II follow-up. Feasibility was determined by the percent of days that >75% of the passive range of motion protocol was completed.

Results

A total of 20 infants were enrolled (70% males) for the present study. The median age at enrolment was 8 days (with a range from 5 to 23), with a median start of intervention at postoperative day 4 (with a range from 2 to 12). The median hospital length of stay following surgery was 15 days (with a range from 9 to 131), with an average of 13.4 (with a range from 3 to 21) in-hospital days per patient. Completion of >75% of the protocol was achieved on 88% of eligible days. Of 11 adverse events reported in six patients, 10 were expected with one determined to be possibly related to the study intervention. There were no clinically significant changes in vital signs. At pre-Stage II follow-up, weight-for-age z-score (−0.84±1.20) and length-for-age z-score (−0.83±1.31) were higher compared with historical controls from two earlier trials.

Conclusion

A passive range of motion exercise programme is safe and feasible in infants with single-ventricle physiology. Larger studies are needed to determine the optimal duration of passive range of motion and its effect on somatic growth.

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Copyright

Corresponding author

Correspondence to: L. M. Lambert, MSN-FNP, Division Cardiothoracic Surgery, Primary Children’s Hospital, 100 North Mario Capecchi Dr., Salt Lake City, UT 84113, United States of America. Tel: +1 801 662 5573; Fax: +1 801 662 5571; E-mail: linda.lambert@hsc.utah.edu

References

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1. Owens, JL, Musa, N. Nutrition support after neonatal cardiac surgery. Nutr Clin Pract 2009; 24: 242249.
2. Menon, G, Poskitt, EM. Why does congenital heart disease cause failure to thrive? Arch Dis Child 1985; 60: 11341139.
3. Burch, PT, Gerstenberger, E, Ravishankar, C, et al. Longitudinal assessment of growth in hypoplastic left heart syndrome: results from the single ventricle reconstruction trial. J Am Heart Assoc 2014; 3: e000079.
4. Williams, RV, Zak, V, Ravishankar, C, et al. Factors affecting growth in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial. J Pediatr 2011; 159: 10171022.e2.
5. Vogt, KN, Manlhiot, C, Van Arsdell, G, Russell, JL, Mital, S, McCrindle, BW. Somatic growth in children with single ventricle physiology impact of physiologic state. J Am Coll Cardiol 2007; 50: 18761883.
6. Pemberton, VL, McCrindle, BW, Barkin, S, et al. Report of the National Heart, Lung, and Blood Institute’s Working Group on obesity and other cardiovascular risk factors in congenital heart disease. Circulation 2010; 121: 11531159.
7. Leitch, CA, Karn, CA, Peppard, RJ, et al. Increased energy expenditure in infants with cyanotic congenital heart disease. J Pediatr 1998; 133: 755760.
8. Lahat, S, Mimouni, FB, Ashbel, G, Dollberg, S. Energy expenditure in growing preterm infants receiving massage therapy. J Am Coll Nutr 2007; 26: 356359.
9. Lambert, LM, Pike, NA, Medoff-Cooper, B, et al. Variation in feeding practices following the Norwood procedure. J Pediatr 2014; 164: 237242.e1.
10. Anderson, JB, Beekman, RH 3rd, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397404.e1.
11. Cohen, MS, Zak, V, Atz, AM, et al. Anthropometric measures after Fontan procedure: implications for suboptimal functional outcome. Am Heart J 2010; 160: 1092-81098.e1.
12. Miller, TA, Zak, V, Shrader, P, et al. Growth asymmetry, head circumference, and neurodevelopmental outcomes in infants with single ventricles. J Pediatr 2016; 168: 220225.e1.
13. Franz, AR, Pohlandt, F, Bode, H, et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 2009; 123: e101e109.
14. Chan, GM, Armstrong, C, Moyer-Mileur, L, Hoff, C. Growth and bone mineralization in children born prematurely. J Perinatol 2008; 28: 619623.
15. Moyer-Mileur, L, Luetkemeier, M, Boomer, L, Chan, GM. Effect of physical activity on bone mineralization in premature infants. J Pediatr 1995; 127: 620625.
16. Moyer-Mileur, LJ, Brunstetter, V, McNaught, TP, Gill, G, Chan, GM. Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants. Pediatrics 2000; 106: 10881092.
17. Field, T, Diego, M, Hernandez-Reif, M. Preterm infant massage therapy research: a review. Infant Behav Dev 2010; 33: 115124.
18. Rutherford, M, Ramenghi, LA, Edwards, AD, et al. Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial. Lancet Neurol 2010; 9: 3945.
19. Dieter, JN, Field, T, Hernandez-Reif, M, Emory, EK, Redzepi, M. Stable preterm infants gain more weight and sleep less after five days of massage therapy. J Pediatr Psychol 2003; 28: 403411.
20. Ferber, SG, Kuint, J, Weller, A, et al. Massage therapy by mothers and trained professionals enhances weight gain in preterm infants. Early Hum Dev 2002; 67: 3745.
21. Kuhn, CM, Schanberg, SM, Field, T, et al. Tactile-kinesthetic stimulation effects on sympathetic and adrenocortical function in preterm infants. J Pediatr 1991; 119: 434440.
22. Als, H, Gilkerson, L, Duffy, FH, et al. A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr 2003; 24: 399408.
23. Control CfD. Retrieved 10 February 2017 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5909a1.htm. September 10, 2010.
24. McQueen, D, Lakes, K, Rich, J, et al. Feasibility of a caregiver-assisted exercise program for preterm infants. J Perinat Neonatal Nurs 2013; 27: 184192.
25. Hsu, DT, Mital, S, Ravishankar, C, et al. Rationale and design of a trial of angiotensin-converting enzyme inhibition in infants with single ventricle. Am Heart J 2009; 157: 3745.
26. Ohye, RG, Sleeper, LA, Mahony, L, et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 2010; 362: 19801992.
27. Langer, VS. Minimal handling protocol for the intensive care nursery. Neonatal Netw 1990; 9: 2327.
28. Long, JG, Philip, AG, Lucey, JF. Excessive handling as a cause of hypoxemia. Pediatrics 1980; 65: 203207.
29. Acolet, D, Modi, N, Giannakoulopoulos, X, et al. Changes in plasma cortisol and catecholamine concentrations in response to massage in preterm infants. Arch Dis Child 1993; 68: 2931.
30. Diego, MA, Field, T, Hernandez-Reif, M, Deeds, O, Ascencio, A, Begert, G. Preterm infant massage elicits consistent increases in vagal activity and gastric motility that are associated with greater weight gain. Acta Paediatr 2007; 96: 15881591.
31. Field, T, Diego, M, Hernandez-Reif, M, et al. Insulin and insulin-like growth factor-1 increased in preterm neonates following massage therapy. J Dev Behav Pediatr 2008; 29: 463466.
32. Guzzetta, A, Baldini, S, Bancale, A, et al. Massage accelerates brain development and the maturation of visual function. J Neurosci 2009; 29: 60426051.

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