The gross motor development of infants following early cardiac surgery

© 2010 Dr. Suzanne Hope LongOver the last two decades, advances in surgical techniques and intensive care for infants undergoing surgery for congenital heart disease (CHD) have led to a significant decline in mortality. Concurrently, concerns relating to brain injury in children undergoing open-heart surgery, and a paucity of developmental follow-up data have been highlighted. The primary aim of this research was to prospectively describe the gross motor development of a sample of infants with CHD, who had undergone cardiac surgery in the neonatal or early infant period. Assessment of gross motor performance was undertaken using the Alberta Infant Motor Scale (AIMS) when study participants were four, eight, 12 and 16 months of age; these longitudinal assessments demonstrated that study participants had delayed gross motor development that persisted across infancy. These findings were illustrated by examination of quantitative scores on the AIMS, as well as by detailed review of individual AIMS items and movement descriptors (related to weight bearing, antigravity movement and postural control). Qualitative analyses highlighted that specific factors were implicated in gross motor delay, including: a lack of trunk extension at four and eight months of age; an imbalance of flexor and extensor muscle control (with flexor abilities surpassing extensor abilities) at four and eight months of age; a lack of active trunk rotation at eight, 12 and 16 months of age; and asymmetry in crawling. Importantly, the overall findings of this study suggested that the qualitative movement characteristics of infants with CHD differ from those of term and pre-term infants. This study also demonstrated that AIMS assessment results could only be discriminated into normal, atypical and suspicious categories in the presence of serial assessment. It was shown that different methods of conversion of AIMS total raw scores to AIMS percentile ranks led to discrepancies in the number of cases, as well as which individual cases, were categorised as having normal, atypical or suspicious gross motor development. Subsequently, this study provided a new, systematic way of interpreting AIMS percentile ranks over time. Data suggested that 62% of study participants did not have age-appropriate motor development in the first year of life. The studies within this thesis provide the first longitudinal account of gross motor development in infants with CHD who had undergone cardiac surgery in the neonatal or early infant period, and validated the use of the AIMS in this patient population. Infants with CHD demonstrated specific impairments in motor skill performance, which contributed to the measured gross motor delay