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Abnormal infant neurobehavior and later neurodevelopmental delays in children with critical CHD

Published online by Cambridge University Press:  14 July 2022

Kathleen Campbell*
Affiliation:
Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Lauren Malik
Affiliation:
Department of Pediatrics, Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA
Courtney Jones
Affiliation:
Department of Pediatrics, Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA
Zhining Ou
Affiliation:
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
Angela Presson
Affiliation:
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
Thomas A. Miller
Affiliation:
Department of Cardiovascular Services, Division of Pediatric Cardiology, Maine Medical Center, Portland, ME, USA
Sarah Winter
Affiliation:
Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
Kristi Glotzbach
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
*
Author for correspondence: Kathleen Campbell, MD, MHSc, 3550 Market St., 3rd Floor, Philadelphia, PA, 19104, USA. Tel: +1 949-887-5307. E-mail: kathleendcampbell@gmail.com

Abstract

Infants with critical CHD have abnormal neurobehavior assessed by the Neonatal ICU Network Neurobehavioral Scales. This retrospective cohort study hypothesized associations between abnormal infant neurobehavior in the first month of life and later neurodevelopmental outcomes at 1−2 years of age. Associations between abnormal infant attention (orienting to and tracking stimuli) on the Neonatal ICU Network Neurobehavioral Scales and later motor, cognitive, and language neurodevelopmental outcomes on the Bayley Scales of Infant Development-III at follow-up were examined with descriptive statistics and univariable and multivariable regression. Multiple imputation was used to account for missing outcome data. 189 infants with critical CHD were included, and 69% had abnormal neurobehavioral attention scores. 58 (31%) returned as toddlers for neurodevelopmental follow-up, of which 23% had motor delay. Abnormal infant attention had high sensitivity (92%, 95% CI 60−100%) but low specificity (36%, 95% CI 23−52%) for later motor delay. Higher infant attention scores were associated with higher later motor scores in univariable analysis (coefficient 3.49, 95% CI 0.52,6.46, p = 0.025), but not in multivariable analyses. Neither cognitive nor language scores were associated with infant attention scores. Lower birth weight and male sex were significantly associated with lower motor scores in multivariable analysis (p = 0.048, 0.007). Although impaired infant attention is interdependent with other clinical and demographic risk factors, it may be a sensitive clinical marker of risk for later motor delay. In children with critical CHD, impaired infant attention may be capturing early signs of abnormal visual-motor neurodevelopment.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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