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Abell B, Rodwell D, Eagleson KJ, Parsonage W, Auld B, Bora S, Kasparian NA, Justo R, McPhail SM. "It's more than just a conversation about the heart": exploring barriers, enablers, and opportunities for improving the delivery and uptake of cardiac neurodevelopmental follow-up care. Front Pediatr 2024; 12:1364190. [PMID: 38863525 PMCID: PMC11165703 DOI: 10.3389/fped.2024.1364190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia. Methods an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis. Results fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data. Discussion Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.
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Affiliation(s)
- Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Rodwell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Accident Research & Road Safety—Queensland (CARRS-Q), School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen J. Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben Auld
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Samudragupta Bora
- Health Services Research Center, University Hospitals Research & Education Institute and Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nadine A. Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
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Vikhe CS, Sharath HV, Brahmane NA, Ramteke SU. The Effect of Physiotherapy Intervention on an Infant With Congenital Heart Defect Associated With Developmental Delay: A Case Report. Cureus 2024; 16:e60215. [PMID: 38868259 PMCID: PMC11167580 DOI: 10.7759/cureus.60215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Congenital heart defects (CHDs) are one of the most prevalent anomalies present at birth globally. Children with CHD often face developmental challenges, including motor, language, and cognitive impairments. This case report presents the clinical profile of a 1.2-year-old female child with CHD and developmental delay (DD) post-CHD surgery. The child exhibited delayed gross motor, fine motor, language, and personal-social milestones, along with significant cardiac anomalies observed on CT angiograms. Physiotherapy interventions were initiated to address these DDs, encompassing manual techniques, neurodevelopmental treatment, and multimodal stimulation. The objective of this study was to assess the impact of physiotherapy interventions on improving developmental outcomes in infants with CHD-associated DD. The New Ballard Score and Hammersmith Infant Neurological Examination were utilized to evaluate improvements post-intervention. Significant enhancements in developmental outcomes were observed. This case underscores the significance of holistic care approaches in mitigating the impact of CHD on developmental trajectories and improving the quality of life for affected children.
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Affiliation(s)
- Chaitali S Vikhe
- Department of Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - H V Sharath
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha A Brahmane
- Department of Pediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Department of Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Abell BR, Eagleson K, Auld B, Bora S, Justo R, Parsonage W, Sharma P, Kularatna S, McPhail SM. Implementing neurodevelopmental follow-up care for children with congenital heart disease: A scoping review with evidence mapping. Dev Med Child Neurol 2024; 66:161-175. [PMID: 37421232 PMCID: PMC10953404 DOI: 10.1111/dmcn.15698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023]
Abstract
AIM To identify and map evidence describing components of neurodevelopmental follow-up care for children with congenital heart disease (CHD). METHOD This was a scoping review of studies reporting components of neurodevelopmental follow-up programmes/pathways for children with CHD. Eligible publications were identified through database searches, citation tracking, and expert recommendations. Two independent reviewers screened studies and extracted data. An evidence matrix was developed to visualize common characteristics of care pathways. Qualitative content analysis identified implementation barriers and enablers. RESULTS The review included 33 studies. Twenty-one described individual care pathways across the USA (n = 14), Canada (n = 4), Australia (n = 2), and France (n = 1). The remainder reported surveys of clinical practice across multiple geographical regions. While heterogeneity in care existed across studies, common attributes included enrolment of children at high-risk of neurodevelopmental delay; centralized clinics in children's hospitals; referral before discharge; periodic follow-up at fixed ages; standardized developmental assessment; and involvement of multidisciplinary teams. Implementation barriers included service cost/resourcing, patient burden, and lack of knowledge/awareness. Multi-level stakeholder engagement and integration with other services were key drivers of success. INTERPRETATION Defining components of effective neurodevelopmental follow-up programmes and care pathways, along with enhancing and expanding guideline-based care across regions and into new contexts, should continue to be priorities. WHAT THIS PAPER ADDS Twenty-two different neurodevelopmental follow-up care pathways/programmes were published, originating from four countries. Twelve additional publications described broad practices for neurodevelopmental follow-up across regions Common attributes across eligibility, service structure, assessment processes, and care providers were noted. Studies reported programme acceptability, uptake, cost, and effectiveness. Implementation barriers included service cost/resourcing, patient burden, and lack of knowledge/awareness.
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Affiliation(s)
- Bridget R. Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Karen Eagleson
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Benjamin Auld
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
| | - Samudragupta Bora
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- University Hospitals Rainbow Babies & Children's HospitalCase Western Reserve University School of MedicineClevelandOHUSA
| | - Robert Justo
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- Royal Brisbane and Women's HospitalMetro North HealthBrisbaneQLDAustralia
| | - Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- Digital Health and Informatics Directorate, Metro South HealthBrisbaneQLDAustralia
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Majnemer A, Brossard-Racine M. Navigating the healthcare system with my child with CHD: parental perspectives on developmental follow-up practices. Cardiol Young 2024; 34:37-43. [PMID: 37138527 DOI: 10.1017/s1047951123001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Parents of children with CHD face several barriers when trying to access the services needed to support their child's development. In fact, current developmental follow-up practices may not identify developmental challenges in a timely manner and important opportunities for interventions may be lost. This study aimed to explore the perspectives of parents of children and adolescents with CHD with respect to developmental follow-up in Canada. METHODS Interpretive description was used as a methodological approach for this qualitative study. Parents of children aged 5-15 years with complex CHD were eligible. Semi-structured interviews that aimed to explore their perspectives regarding their child's developmental follow-up were conducted. RESULTS Fifteen parents of children with CHD were recruited for this study. They expressed that the lack of systematic and responsive developmental follow-up services and limited access to resources to support their child's development placed an undue burden on their families, and as a result, they needed to assume new roles as case managers or advocates to address these limitations. This additional burden resulted in a high level of parental stress, which, in turn, affected the parent-child relationship and siblings. CONCLUSIONS The limitations of the current Canadian developmental follow-up practices put undue pressure on the parents of children with complex CHD. The parents stressed the importance of implementing a universal and systematic approach to developmental follow-up to allow for the timely identification of challenges, enabling the initiation of interventions and supports and promoting more positive parent-child relationships.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Eva Sokol
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Delgado C, Ullery MA, Zeng G, Simpson EA, Tanner JP, Kirby RS, Duclos C, Lowry J, Salemi JL. Elevated risk for developmental disabilities in children with congenital heart defects. Birth Defects Res 2023; 115:1708-1722. [PMID: 37681320 DOI: 10.1002/bdr2.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level. METHODS Statewide birth, birth defects, and preschool developmental disability records were integrated. The final sample included 1,966,585 children (51.0% male). Children were grouped by type(s) of CHD: critical CHD, noncritical CHD, atrial septal defect, or no major birth defects (groups were mutually exclusive). RESULTS Children with a CHD (any type) were at increased risk for developmental disability (any type) (RR 2.08, 95% CI 2.03-2.14, P < .001). Children in the critical CHD, noncritical CHD, and atrial septal defect groups were at increased risk for developmental delay, intellectual disability, language impairment, other health impairment, and any disability. Children in the atrial septal defect group were at increased risk for autism spectrum disorder and speech impairment. For all CHD groups, risk was greatest for other health impairment and intellectual disability. CONCLUSIONS Increased risk for developmental disabilities was identified for children with less severe CHDs as well as for children with more severe (critical) CHDs. All children with CHDs should be closely monitored so that appropriate interventions can be initiated as early as possible to maximize learning outcomes.
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Affiliation(s)
- Christine Delgado
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Mary Anne Ullery
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Guangyu Zeng
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | | | - J P Tanner
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Chris Duclos
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Joseph Lowry
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Jason L Salemi
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
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Simard MN, Lepage C, Gaudet I, Paquette N, Doussau A, Poirier NC, Beauchamp MH, Côté SM, Pinchefsky E, Brossard-Racine M, Mâsse B, Gallagher A. A Parent-child yoga intervention for reducing attention deficits in children with congenital heart disease: the Yoga for Little Hearts Feasibility Study Protocol. BMJ Open 2023; 13:e079407. [PMID: 37848299 PMCID: PMC10582886 DOI: 10.1136/bmjopen-2023-079407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Preschoolers and school-aged children with congenital heart disease (CHD) are at higher risk of attention deficit hyperactivity disorder (ADHD) compared with the general population. To this day, no randomised controlled trial (RCT) aiming to improve attention has been conducted in young children with CHD. There is emerging evidence indicating that parent-child yoga interventions improve attention and reduce ADHD symptoms in both typically developing and clinical populations. METHODS AND ANALYSIS This is a single-blind, two-centre, two-arm trial during which 24 children with CHD and their parents will be randomly assigned to (1) a parent-child yoga intervention in addition to standard clinical care or (2) standard clinical care alone. All participants will undergo standardised assessments: (1) at baseline, (2) immediately post-treatment and (3) 6 months post-treatment. Descriptive statistics will be used to estimate the feasibility and neurodevelopmental outcomes. This feasibility study will evaluate: (1) recruitment capacity; (2) retention, drop-out and withdrawal rates during the yoga programme and at the 6-month follow-up; (3) adherence to the intervention; (4) acceptability of the randomisation process by families; (5) heterogeneity in the delivery of the intervention between instructors and use of home-based exercises between participants; (6) proportion of missing data in the neurodevelopmental assessments and (7) SD of primary outcomes of the full RCT in order to determine the future appropriate sample size. ETHICS AND DISSEMINATION Ethical approval has been obtained by the Research Ethics Board of the Sainte-Justine University Hospital. The findings will be disseminated in peer-reviewed journals and conferences and presented to the Canadian paediatric grand round meetings. TRIAL REGISTRATION NUMBER NCT05997680.
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Affiliation(s)
- Marie-Noëlle Simard
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Charles Lepage
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Gaudet
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Health Sciences, Universite du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Natacha Paquette
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Amélie Doussau
- Clinique d'investigation neurocardiaque, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Nancy C Poirier
- Clinique d'investigation neurocardiaque, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Surgery, Division of Cardiac Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Miriam H Beauchamp
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sylvana M Côté
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Elana Pinchefsky
- Clinique d'investigation neurocardiaque, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, Centre universitaire de santé McGill, Montréal, Québec, Canada
- Institut de recherche, Centre universitaire de santé McGill, Montréal, Québec, Canada
| | - Benoît Mâsse
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
- Institut de recherche clinique et appliquée, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Anne Gallagher
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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Ortinau CM, Wypij D, Ilardi D, Rofeberg V, Miller TA, Donohue J, Reichle G, Seed M, Elhoff J, Alexander N, Allen K, Anton C, Bear L, Boucher G, Bragg J, Butcher J, Chen V, Glotzbach K, Hampton L, Lee CK, Ly LG, Marino BS, Martinez-Fernandez Y, Monteiro S, Ortega C, Peyvandi S, Raiees-Dana H, Rollins CK, Sadhwani A, Sananes R, Sanz JH, Schultz AH, Sood E, Tan A, Willen E, Wolfe KR, Goldberg CS. Factors Associated With Attendance for Cardiac Neurodevelopmental Evaluation. Pediatrics 2023; 152:e2022060995. [PMID: 37593818 PMCID: PMC10530086 DOI: 10.1542/peds.2022-060995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neurodevelopmental evaluation of toddlers with complex congenital heart disease is recommended but reported frequency is low. Data on barriers to attending neurodevelopmental follow-up are limited. This study aims to estimate the attendance rate for a toddler neurodevelopmental evaluation in a contemporary multicenter cohort and to assess patient and center level factors associated with attending this evaluation. METHODS This is a retrospective cohort study of children born between September 2017 and September 2018 who underwent cardiopulmonary bypass in their first year of life at a center contributing data to the Cardiac Neurodevelopmental Outcome Collaborative and Pediatric Cardiac Critical Care Consortium clinical registries. The primary outcome was attendance for a neurodevelopmental evaluation between 11 and 30 months of age. Sociodemographic and medical characteristics and center factors specific to neurodevelopmental program design were considered as predictors for attendance. RESULTS Among 2385 patients eligible from 16 cardiac centers, the attendance rate was 29.0% (692 of 2385), with a range of 7.8% to 54.3% across individual centers. In multivariable logistic regression models, hospital-initiated (versus family-initiated) scheduling for neurodevelopmental evaluation had the largest odds ratio in predicting attendance (odds ratio = 4.24, 95% confidence interval, 2.74-6.55). Other predictors of attendance included antenatal diagnosis, absence of Trisomy 21, higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category, longer postoperative length of stay, private insurance, and residing a shorter distance from the hospital. CONCLUSIONS Attendance rates reflect some improvement but remain low. Changes to program infrastructure and design and minimizing barriers affecting access to care are essential components for improving neurodevelopmental care and outcomes for children with congenital heart disease.
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Affiliation(s)
- Cynthia M. Ortinau
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - David Wypij
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, United States; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States; Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, United States
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Thomas A. Miller
- Division of Cardiology, Maine Medical Center, Portland, Maine, United States
| | - Janet Donohue
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, United States
| | - Garrett Reichle
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, United States
| | - Mike Seed
- Department of Paediatrics, Division of Paediatric Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Justin Elhoff
- Department of Pediatrics, Division of Critical Care Medicine, Baylor School of Medicine, Houston, Texas, United States
| | - Nneka Alexander
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Kiona Allen
- Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Corinne Anton
- Department of Cardiology, Children’s Health, Dallas, Texas, United States; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Laurel Bear
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Gina Boucher
- Phoenix Children’s Hospital Heart Center, Phoenix, Arizona, United States
| | - Jennifer Bragg
- Department of Pediatrics, Mount Sinai Hospital, New York, New York, United States
| | - Jennifer Butcher
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, United States
| | - Victoria Chen
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Cohen Children’s Medical Center, New Hyde Park, New York, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Kristi Glotzbach
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Lyla Hampton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Caroline K. Lee
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Linh G. Ly
- Department of Paediatrics, Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Cleveland, Ohio, United States
| | | | - Sonia Monteiro
- Department of Pediatrics, Baylor School of Medicine, Houston, Texas, United States
| | - Christina Ortega
- Department of Psychology, Joe DiMaggio Children’s Hospital, Hollywood, Florida, United States
| | - Shabnam Peyvandi
- University of California San Francisco Benioff Children’s Hospital, San Francisco, California, United States
| | | | - Caitlin K. Rollins
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States; Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anjali Sadhwani
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, United States; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Renee Sananes
- Department of Psychology, Division of Cardiology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jacqueline H. Sanz
- Division of Neuropsychology, Children’s National Hospital; Departments of Psychiatry and Behavioral Sciences & Pediatrics, The George Washington University School of Medicine, Washington D.C., United States
| | - Amy H. Schultz
- Division of Cardiology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington, United States
| | - Erica Sood
- Nemours Cardiac Center, Nemours Children’s Health, Wilmington, Delaware, United States; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Alexander Tan
- Department of Neuropsychology, Children’s Health Orange County, Orange, California, United States
| | - Elizabeth Willen
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, United States
| | - Kelly R. Wolfe
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Caren S. Goldberg
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, United States
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Brossard-Racine M, Majnemer A. Identifying developmental challenges of youth with congenital heart defects: A patient-oriented perspective. Child Care Health Dev 2023; 49:258-267. [PMID: 35945137 DOI: 10.1111/cch.13037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with congenital heart disease (CHD) are at high risk for a range of developmental impairments that become evident at different times across childhood and adolescence. This study aimed to explore perspectives of youth with CHD with respect to their developmental follow-up across childhood. METHODS Interpretive description was used as a methodological approach for this qualitative study. Youth aged 12-22 years with CHD requiring open-heart surgery before 2 years of age and who had received health services in Canada since birth were enrolled. RESULTS Ten youth with CHD, two males and eight females, aged 13-22 years (mean 19.8) participated in this study. With higher social and academic demands as well as increased level of autonomy associated with older age, some youth faced new challenges that they had not encountered as children. Youth with CHD identified four aspects of the continuum of care as needing to be changed to better respond to their needs. First, the format of developmental follow-up needs to be adapted to their unique challenges. Second, resources must be more easily accessible throughout childhood and adolescence. Third, planning for transition to adult care is essential to ensure continuity of services. Finally, they identified that the school system is an essential component of the continuum of care. CONCLUSIONS Adolescents and young adults with CHD are at high risk of developing physical, academic and psychosocial challenges; however, timely identification of challenges does not appear to be optimal across domains and transition points, from the perspective of the youth themselves. Youth with CHD reported not having the resources and supports they required to optimize their functioning. Our findings suggest that several approaches could be adopted to enhance identification and outcomes to address the limitations of current Canadian practices.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.,Ingram School of Nursing, McGill University, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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9
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Feldmann M, Hagmann C, de Vries L, Disselhoff V, Pushparajah K, Logeswaran T, Jansen NJG, Breur JMPJ, Knirsch W, Benders M, Counsell S, Reich B, Latal B. Neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices in neonatal congenital heart disease: a European survey. Pediatr Res 2023; 93:168-175. [PMID: 35414671 PMCID: PMC9876786 DOI: 10.1038/s41390-022-02063-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Brain injury and neurodevelopmental impairment remain a concern in children with complex congenital heart disease (CHD). A practice guideline on neuromonitoring, neuroimaging, and neurodevelopmental follow-up in CHD patients undergoing cardiopulmonary bypass surgery is lacking. The aim of this survey was to systematically evaluate the current practice in centers across Europe. METHODS An online-based structured survey was sent to pediatric cardiac surgical centers across Europe between April 2019 and June 2020. Results were summarized by descriptive statistics. RESULTS Valid responses were received by 25 European centers, of which 23 completed the questionnaire to the last page. Near-infrared spectroscopy was the most commonly used neuromonitoring modality used in 64, 80, and 72% preoperatively, intraoperatively, and postoperatively, respectively. Neuroimaging was most commonly performed by means of cranial ultrasound in 96 and 84% preoperatively and postoperatively, respectively. Magnetic resonance imaging was obtained in 72 and 44% preoperatively and postoperatively, respectively, but was predominantly reserved for clinically symptomatic patients (preoperatively 67%, postoperatively 64%). Neurodevelopmental follow-up was implemented in 40% of centers and planned in 24%. CONCLUSIONS Heterogeneity in perioperative neuromonitoring and neuroimaging practice in CHD in centers across Europe is large. The need for neurodevelopmental follow-up has been recognized. A clear practice guideline is urgently needed. IMPACT There is large heterogeneity in neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices among European centers caring for neonates with complex congenital heart disease. This study provides a systematic evaluation of the current neuromonitoring, neuroimaging, and neurodevelopmental follow-up practice in Europe. The results of this survey may serve as the basis for developing a clear practice guideline that could help to early detect and prevent neurological and neurodevelopmental sequelae in neonates with complex congenital heart disease.
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Affiliation(s)
- Maria Feldmann
- grid.412341.10000 0001 0726 4330Child Development Centre, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Children’s Research Centre, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- grid.412341.10000 0001 0726 4330Children’s Research Centre, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Department of Neonatology and Pediatric Intensive Care, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Linda de Vries
- grid.5477.10000000120346234Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Vera Disselhoff
- grid.412341.10000 0001 0726 4330Child Development Centre, University Children’s Hospital Zurich, Zurich, Switzerland ,grid.412341.10000 0001 0726 4330Children’s Research Centre, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Kuberan Pushparajah
- Pediatric Cardiology Department, Evelina Children’s Hospital London, London, UK ,grid.13097.3c0000 0001 2322 6764Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Thushiha Logeswaran
- grid.8664.c0000 0001 2165 8627Pediatric Heart Center, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Nicolaas J. G. Jansen
- grid.417100.30000 0004 0620 3132Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes M. P. J. Breur
- grid.417100.30000 0004 0620 3132Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Walter Knirsch
- grid.412341.10000 0001 0726 4330Pediatric Cardiology, Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Manon Benders
- grid.5477.10000000120346234Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands ,grid.417100.30000 0004 0620 3132Department of Neonatology, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Serena Counsell
- grid.13097.3c0000 0001 2322 6764Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Bettina Reich
- grid.472754.70000 0001 0695 783XPediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Munich, Germany
| | - Beatrice Latal
- Child Development Centre, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.
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10
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Wehrle FM, Bartal T, Adams M, Bassler D, Hagmann CF, Kretschmar O, Natalucci G, Latal B. Similarities and Differences in the Neurodevelopmental Outcome of Children with Congenital Heart Disease and Children Born Very Preterm at School Entry. J Pediatr 2022; 250:29-37.e1. [PMID: 35660491 DOI: 10.1016/j.jpeds.2022.05.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the similarities and differences in the neurodevelopmental outcome of children with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery compared with children born very preterm (VPT) at school entry. STUDY DESIGN IQ, motor abilities, behavior, and therapy use were assessed in 155 children with CHD as part of a prospective, single-center, longitudinal study, and in 251 children born VPT as part of a national follow-up register at the same center. Group differences were tested using independent t-tests and χ2-tests. Equivalence testing was used to investigate similarities between the groups. RESULTS Mild (ie, 70 ≤ IQ < 85) and severe intellectual impairments (ie, IQ < 70) occurred in 17.4% and 4.5% of children with CHD compared with 22.1% and 5.5% in children VPT, respectively. Motor and behavioral functions were impaired in 57.0% and 15.3% of children with CHD compared with 37.8% and 11.5% of children born VPT, respectively. Children with CHD had poorer global motor abilities (d = -0.26) and poorer dynamic balance (d = -0.62) than children born VPT, and children born VPT had poorer fine motor abilities than children with CHD (d = 0.34; all P < .023). Peer problems were statistically similar between the groups (P = .020). Therapies were less frequent in children with CHD compared with children born VPT (23.4% vs 40.3%; P < .001). CONCLUSIONS Children with CHD undergoing cardiopulmonary bypass surgery and children born VPT share an overall risk for neurodevelopmental impairments that manifest in different domains. Despite this, children with CHD receive fewer therapies, indicating a lack of awareness of the neurodevelopmental burden these children face.
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Affiliation(s)
- Flavia M Wehrle
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Timm Bartal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Newborn Research, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Cornelia F Hagmann
- Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Department of Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Giancarlo Natalucci
- Newborn Research, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Family Larsson-Rosenquist Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
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11
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Eagleson K, Justo R. Lessons From the Queensland Paediatric Cardiac Service Neurodevelopmental Follow-up Programme. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:101-104. [PMID: 37970490 PMCID: PMC10642086 DOI: 10.1016/j.cjcpc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2023]
Affiliation(s)
- Karen Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Children’s Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Children’s Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
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