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Michelon RC, Lucchese-Lobato F. A remote parent-led early intervention protocol to promote motor development in infants with congenital heart disease: a feasibility pilot study of a randomized clinical trial. Dev Neurorehabil 2024:1-11. [PMID: 38922306 DOI: 10.1080/17518423.2024.2365796] [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] [Received: 09/07/2023] [Accepted: 06/05/2024] [Indexed: 06/27/2024]
Abstract
This study evaluated the feasibility of a parent-led, home-based early intervention for motor development in infants with Congenital Heart Disease (CHD), part of a larger multicenter, single-blind randomized controlled trial (ClinicalTrials.gov NCT05907109). Parents, supported by remote specialists weekly, engaged in multidomain stimulation activities five days a week, for six months. Feasibility was assessed via parental questionnaires, adherence rates, and infant motor development assessments. Despite high dropout and mortality rates, results showed 80% adherence, 91% parental satisfaction, 75% availability, and 60% self-efficacy. No significant motor skill differences were noted between the intervention (IG; n = 19) and control groups (CG; n = 11) at six months, but the higher baseline risk in IG suggests promotion of motor skills in the intervention group. Future studies in Brazil might extend the study duration to address high dropout and mortality rates.
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Affiliation(s)
- Rita Cassiana Michelon
- Programa de Pós-Graduação em Ciências da Saúde, Institute of Cardiology - University Foundation of Cardiology (IC-FUC), Porto Alegre, Brazil
| | - Fernanda Lucchese-Lobato
- Programa de Pós-Graduação em Ciências da Saúde, Institute of Cardiology - University Foundation of Cardiology (IC-FUC), Porto Alegre, Brazil
- Hospital Santo Antônio, Irm. Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Child and Adolescent Psychiatry Dept., Columbia University Irving Medical Center, New York, USA
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2
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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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Hofer J, Blum M, Wiltsche R, Deluggi N, Holzinger D, Fellinger J, Tulzer G, Blum G, Oberhuber R. Research gaps in the neurodevelopmental assessment of children with complex congenital heart defects: a scoping review. Front Pediatr 2024; 12:1340495. [PMID: 38846331 PMCID: PMC11155449 DOI: 10.3389/fped.2024.1340495] [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: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 06/09/2024] Open
Abstract
Background Children with congenital heart defects (CHD) are at risk for a range of developmental disabilities that challenge cognition, executive functioning, self-regulation, communication, social-emotional functioning, and motor skills. Ongoing developmental surveillance is therefore key to maximizing neurodevelopmental outcome opportunities. It is crucial that the measures used cover the spectrum of neurodevelopmental domains relevant to capturing possible predictors and malleable factors of child development. Objectives This work aimed to synthesize the literature on neurodevelopmental measures and the corresponding developmental domains assessed in children aged 1-8 years with complex CHD. Methods PubMed was searched for terms relating to psycho-social, cognitive and linguistic-communicative outcomes in children with CHD. 1,380 papers with a focus on complex CHD that reported neurodevelopmental assessments were identified; ultimately, data from 78 articles that used standardized neurodevelopmental assessment tools were extracted. Results Thirty-nine (50%) of these excluded children with syndromes, and 9 (12%) excluded children with disorders of intellectual development. 10% of the studies were longitudinal. The neurodevelopmental domains addressed by the methods used were: 53% cognition, 16% psychosocial functioning, 18% language/communication/speech production, and 13% motor development-associated constructs. Conclusions Data on social communication, expressive and receptive language, speech motor, and motor function are underrepresented. There is a lack of research into everyday use of language and into measures assessing language and communication early in life. Overall, longitudinal studies are required that include communication measures and their interrelations with other developmental domains.
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Affiliation(s)
- Johannes Hofer
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
| | - Marina Blum
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Regina Wiltsche
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Nikoletta Deluggi
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Daniel Holzinger
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
- Institute of Linguistics, University of Graz, Graz, Austria
| | - Johannes Fellinger
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
- Division of Social Psychiatry, University Clinic for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerald Tulzer
- Department of Pediatric Cardiology, Children’s Heart Center Linz, Kepler University Hospital, Linz, Austria
| | - Gina Blum
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Raphael Oberhuber
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Department of Pediatric Cardiology, Children’s Heart Center Linz, Kepler University Hospital, Linz, Austria
- Department of Inclusive Education, University of Education Upper Austria, Linz, Austria
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4
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Gold A, Wray J, Kosmach-Park B, Bannister L, Wichart J, Graham A, Piotrowski C, Mayersohn G, Shellmer DA, Patterson C. Allied health and nursing practices in pediatric solid organ transplantation: An international survey. Pediatr Transplant 2024; 28:e14541. [PMID: 37550265 DOI: 10.1111/petr.14541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION With improved survival in pediatric solid organ transplantation (SOT) care has focused on optimizing functional, developmental, and psychosocial outcomes, roles often supported by Allied Health and Nursing professionals (AHNP). However, there is a scarcity of research examining frameworks of clinical practice. METHODS The International Pediatric Transplant Association AHNP Committee developed and disseminated an online survey to transplant centers as a quality improvement project to explore AHNP practice issues. Participant responses were characterized using descriptive statistics, and free-text comments were thematically analyzed. Responses were compared across professional groups; Group 1: Advanced Practice Providers, Group 2: Nursing, Group 3: Allied Health. RESULTS The survey was completed by 119 AHNP from across the globe, with responses predominantly (78%) from North America. Half of respondents had been working in pediatric transplant for 11+ years. Two-thirds of respondents were formally funded to provide transplant care; however, of these not funded, over half (57%) were allied health, compared to just 6% of advance practice providers. Advanced practice/nursing groups typically provided care to one organ program, with allied health providing care for multiple organ programs. Resource constraints were barriers to practice across all groups and countries. CONCLUSION In this preliminary survey exploring AHNP roles, professionals provided a range of specialized clinical care. Challenges to practice were funding and breadth of care, highlighting the need for additional resources, alongside the development of clinical practice guidelines for defining, and supporting the role of AHNP within pediatric SOT. Professional organizations, such as IPTA, can offer professional advocacy.
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Affiliation(s)
- Anna Gold
- The Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Beverly Kosmach-Park
- Department of Transplant Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - Louise Bannister
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jenny Wichart
- Department of Pharmacy, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Ashley Graham
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, The University of Toronto, Toronto, Ontario, Canada
| | - Caroline Piotrowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gillian Mayersohn
- St. Louis Children's Hospital, St. Louis, Missouri, USA
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Diana A Shellmer
- Department of Surgery, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine Patterson
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Department of Rehabilitation Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ubeda Tikkanen A, Vova J, Holman L, Chrisman M, Clarkson K, Santiago R, Schonberger L, White K, Badaly D, Gauthier N, Pham TDN, Britt JJ, Crouter SE, Giangregorio M, Nathan M, Akamagwuna UO. Core components of a rehabilitation program in pediatric cardiac disease. Front Pediatr 2023; 11:1104794. [PMID: 37334215 PMCID: PMC10275574 DOI: 10.3389/fped.2023.1104794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training.
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Affiliation(s)
- Ana Ubeda Tikkanen
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Joshua Vova
- Department of Physiatry, Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Lainie Holman
- Department Pediatric Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - Maddie Chrisman
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kristin Clarkson
- Department of Pediatric Physical Medicine and Rehabilitation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Santiago
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Lisa Schonberger
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Kelsey White
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY, United States
| | - Naomi Gauthier
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Tam Dan N. Pham
- Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Jolie J. Britt
- Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Scott E. Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee Knoxville, Knoxville, IL, United States
| | - Maeve Giangregorio
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
| | - Unoma O. Akamagwuna
- Department Pediatric Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, United States
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, TX, United States
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6
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Basgoze S, Temur B, Ozcan ZS, Gokce I, Guvenc O, Aydin S, Guzelmeric F, Altan Kus A, Erek E. The effect of extracorporeal membrane oxygenation on neurodevelopmental outcomes in children after repair of congenital heart disease: A pilot study from Turkey. Front Pediatr 2023; 11:1131361. [PMID: 37077331 PMCID: PMC10106672 DOI: 10.3389/fped.2023.1131361] [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: 12/24/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) is widely used after congenital heart surgery. The purpose of this study is to analyze the neurodevelopmental (ND) outcomes in patients who receivedECMO support after congenital cardiac surgery. Methods Between January 2014 and January 2021, 111 patients (5.8%) receivedECMO support after congenital heart operations, and 29 (26,1%) of these patients were discharged. Fifteen patients who met the inclusion criteria were included. A propensity score matching (PSM) analysis model was established using eight variables (age, weight, sex, Modified Aristotle Comprehensive Complexityscores, seizures, cardiopulmonary bypass duration, number of operations, and repair method) with 1:1 matching. According to the PSM model, 15 patients who underwent congenital heart operations were selected as the non-ECMO group. The Ages & Stages Questionnaire Third Edition (ASQ-3) was used for ND screening;it includes communication, physical skills (gross and fine motor), problem-solving, and personal-social skills domains. Results There were no statistically significant differences between the patients' preoperative and postoperative characteristics. All patients were followed up for a median of 29 months (9-56 months). The ASQ-3 results revealed that communication, fine motor, and personal-social skills assessments were not statistically different between the groups. Gross motor skills (40 vs. 60), problem-solving skills (40 vs. 50), and overall scores (200 vs. 250) were better in the non-ECMO patients (P = 0.01, P = 0.03, and P = 0.03, respectively). Nine patients (%60) in the ECMO group and 3 patients (%20) in the non-ECMO group were with neurodevelopmental delay (P = 0,03). Conclusion ND delay may occur in congenital heart surgery patients who receivedECMO support. We recommend ND screening in all patients with congenital heart disease, especially those who receivedECMO support.
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Affiliation(s)
- Serdar Basgoze
- Department of Pediatric Heart Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
- Correspondence: Serdar Basgoze
| | - Bahar Temur
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Zeynep Sila Ozcan
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Ibrahim Gokce
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Osman Guvenc
- Department of Pediatric Cardiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Selim Aydin
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Fusun Guzelmeric
- Department of Anesthesiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Aylin Altan Kus
- Department of Radiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Heart Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
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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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8
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Williams CN, Hall TA, Francoeur C, Kurz J, Rasmussen L, Hartman ME, O'meara AI, Ferguson NM, Fink EL, Walker T, Drury K, Carpenter JL, Erklauer J, Press C, Wainwright MS, Lovett M, Dapul H, Murphy S, Risen S, Guerriero RM, Woodruff A, Guilliams KP. Continuing Care For Critically Ill Children Beyond Hospital Discharge: Current State of Follow-up. Hosp Pediatr 2022; 12:359-393. [PMID: 35314865 PMCID: PMC9182716 DOI: 10.1542/hpeds.2021-006464] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Survivors of the PICU face long-term morbidities across health domains. In this study, we detail active PICU follow-up programs (PFUPs) and identify perceptions and barriers about development and maintenance of PFUPs. METHODS A web link to an adaptive survey was distributed through organizational listservs. Descriptive statistics characterized the sample and details of existing PFUPs. Likert responses regarding benefits and barriers were summarized. RESULTS One hundred eleven respondents represented 60 institutions located in the United States (n = 55), Canada (n = 3), Australia (n = 1), and the United Kingdom (n = 1). Details for 17 active programs were provided. Five programs included broad PICU populations, while the majority were neurocritical care (53%) focused. Despite strong agreement on the need to assess and treat morbidity across multiple health domains, 29% were physician only programs, and considerable variation existed in services provided by programs across settings. More than 80% of all respondents agreed PFUPs provide direct benefits and are essential to advancing knowledge on long-term PICU outcomes. Respondents identified "lack of support" as the most important barrier, particularly funding for providers and staff, and lack of clinical space, though successful programs overcome this challenge using a variety of funding resources. CONCLUSIONS Few systematic multidisciplinary PFUPs exist despite strong agreement about importance of this care and direct benefit to patients and families. We recommend stakeholders use our description of successful programs as a framework to develop multidisciplinary models to elevate continuity across inpatient and outpatient settings, improve patient care, and foster collaboration to advance knowledge.
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Affiliation(s)
- Cydni N Williams
- Divisions of Pediatric Critical Care.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Trevor A Hall
- Pediatric Psychology.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Conall Francoeur
- Department of Pediatrics, CHU de Québec - Université Laval Research Center, Quebec, QC, Canada
| | - Jonathan Kurz
- Translational Pharmacology, Merck & Co., Inc., North Wales, Pennsylvania
| | - Lindsey Rasmussen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Mary E Hartman
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Am Iqbal O'meara
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Nikki Miller Ferguson
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracie Walker
- Division of Pediatric Critical Care, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | | | - Jessica L Carpenter
- Division of Pediatric Neurology, Departments of Pediatrics and Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Erklauer
- Sections of Critical Care Medicine and Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Craig Press
- Section of Child Neurology, Department of Pediatrics, University of Colorado, Boulder, Colorado
| | - Mark S Wainwright
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington
| | - Marlina Lovett
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Heda Dapul
- Division of Pediatric Critical Care, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Sarah Murphy
- Division of Pediatric Critical Care, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sarah Risen
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rejean M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Alan Woodruff
- Section of Pediatric Critical Care, Department of Anesthesiology.,Critical Illness, Injury and Recovery Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristin P Guilliams
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.,Section of Pediatric Critical Care, Department of Anesthesiology.,Washington University School of Medicine, Mallinckrodt Institute of Radiology, Division of Neuroradiology, St. Louis, Missouri
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9
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Lépine J, Gagnon K, Prud'homme J, Vinay MC, Doussau A, Fourdain S, Provost S, Belval V, Bernard C, Gallagher A, Poirier N, Simard MN. Utility of the Ages and Stages Questionnaires 3rd Edition for Developmental Screening in Children with Surgically Repaired Congenital Heart Disease. Dev Neurorehabil 2022; 25:125-132. [PMID: 34365887 DOI: 10.1080/17518423.2021.1960918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aim: This study sought to evaluate the accuracy of the Ages and Stages Questionnaires 3rd Edition (ASQ-3) in identifying developmental delay (DD) in children with congenital heart disease (CHD) born at term who underwent surgical repair.Methods: Participants had to complete ASQ-3 and Bayley Scales of Infant and Toddler Development 3rd Edition (BSID-III) at 12 and 24 months. A child was considered at risk of DD for a ASQ-3 domain when he scored below the cutoff (≤-1SD or ≤-2SD). A child had a DD in a BSID-III domain when the score was ≤-1SD. The validity for each ASQ-3 domain and for overall ASQ-3 was measured.Results: At 12 months (n = 64), overall ASQ-3 (≤-2SD) sensitivity was 88%, specificity 74%. At 24 months (n = 82), overall ASQ-3 (≤-2SD) sensitivity was 74%, specificity 88%.Conclusion: The results support the utility of the ASQ-3 for screening the overall risk of DD in children with CHD.
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Affiliation(s)
- Julien Lépine
- Faculty of Medicine, Université De Montréal, Montreal, Quebec, Canada
| | - Karine Gagnon
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Joëlle Prud'homme
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Marie Claude Vinay
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Amélie Doussau
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Solène Fourdain
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada.,Department of Psychology, Université De Montréal, Montreal, Quebec, Canada
| | - Sarah Provost
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada.,Department of Psychology, Université De Montréal, Montreal, Quebec, Canada
| | - Véronique Belval
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Catherine Bernard
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Anne Gallagher
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada.,Department of Psychology, Université De Montréal, Montreal, Quebec, Canada
| | - Nancy Poirier
- Faculty of Medicine, Université De Montréal, Montreal, Quebec, Canada.,Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada
| | - Marie-Noëlle Simard
- Sainte-Justine University Health Centre Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medecine, Université De Montréal, Montreal, Quebec, Canada
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10
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Bolduc ME, Rennick JE, Gagnon I, Majnemer A, Brossard-Racine M. Canadian Developmental Follow-up Practices in Children With Congenital Heart Defects: A National Environmental Scan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:3-10. [PMID: 37969558 PMCID: PMC10642138 DOI: 10.1016/j.cjcpc.2021.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2023]
Abstract
Background Developmental follow-up is central to the timely identification of delays in at-risk children. Throughout Canada, data are currently lacking on the follow-up of children with congenital heart disease (CHD) after open-heart surgery. The objective of this study was to describe current Canadian developmental follow-up practices and to explore barriers to optimal follow-up. Methods A cross-sectional study was implemented with health professionals involved with the developmental follow-up of children with CHD in the 8 specialized hospitals that perform pediatric open-heart surgery in Canada. A questionnaire collected descriptive information about the setting and current follow-up practices. In addition, an interview was conducted to explore what would be considered optimal developmental follow-up in Canada and identify potential barriers. Results Four of the 8 tertiary care centres had a systematic developmental follow-up program that included screening and formal evaluation. These programs were only accessible to a subset of children with CHD identified to be at higher risk. Participants described current practices as suboptimal and aimed to develop a more systematic developmental follow-up program or expand an existing one. Participants emphasized the lack of human resources, financial supports, and limited dedicated time as major barriers to offering optimal follow-up care. Conclusions Current follow-up practices in Canada are considered suboptimal by health care specialists involved in treating children with CHD. These practices may fail to promptly identify children and adolescents with CHD who have developmental challenges. It is essential that we develop national recommendations to optimize the developmental follow-up practices in Canada for this high-risk population.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Advances in Brain and Child Development Research Laboratory, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Janet E. Rennick
- Department of Nursing, The Montreal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Advances in Brain and Child Development Research Laboratory, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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11
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Song KJ, Kim MG, Ko EJ, Sung IY. Neurodevelopmental Outcomes after Congenital Heart Disease Surgery in Infancy: A 2-Year Serial Follow-Up. CHILDREN-BASEL 2021; 8:children8100911. [PMID: 34682176 PMCID: PMC8534389 DOI: 10.3390/children8100911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to assess the neurodevelopmental status of infant patients who underwent cardiac surgery in infancy and to investigate the factors affecting the neurodevelopmental status. METHODS This retrospective study included 108 patients who underwent cardiac surgery before the age of one. We used the Bayley Scales of Infant Development II to evaluate the neurodevelopmental status. All patients were analyzed according to the presence of the syndrome. Patients without the syndrome were analyzed according to the presence of brain lesions. RESULTS The mean mental developmental index (MDI) and the mean psychomotor developmental index (PDI) were 76.11 ± 20.17 and 65.95 ± 18.34, respectively, in the first evaluation, and 73.98 ± 22.53 and 69.48 ± 20.86, respectively, in the second evaluation. In the subgroup analysis, no significant difference was observed between the first evaluation and the second evaluation. CONCLUSIONS No significant difference was observed in the degree of development of the patients in the two evaluation periods. Although the presence of syndrome, brain lesion, or gestational age affected the degree of developmental delay, more than half of the patients had developmental delay in the two evaluation periods in any of the subgroup. Therefore, the necessity of early screening and early rehabilitation intervention is emphasized.
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12
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Long DA, Fink EL. Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice. Transl Pediatr 2021; 10:2858-2874. [PMID: 34765507 PMCID: PMC8578758 DOI: 10.21037/tp-21-61] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Most children are surviving critical illness in highly resourced pediatric intensive care units (PICUs). However, in research studies, many of these children survive with multi-domain health sequelae that has the potential to affect development over many years, termed post-intensive care syndrome-pediatrics (PICS-p). Clinically, there are no recommendations for the assessment and follow-up of children with critical illness as exists for the premature neonatal and congenital heart disease populations. In research studies, primary and secondary outcomes are largely assessed at or prior to hospital discharge, disregarding post-hospital outcomes important to PICU stakeholders. Incorporating longer term outcomes into clinical and research programs, however, can no longer be overlooked. Barriers to outcomes assessments are varied and generalized vs. individualized, but some PICU centers are discovering how to overcome them and are providing this service to families-sometimes specific populations-in need. Research programs and funders are increasingly recognizing the value and need to assess long-term outcomes post-PICU. Finally, we should seek the strong backing of the PICU community and families to insist that long-term outcomes become our new clinical standard of care. PICUs should consider development of a multicenter, multinational collaborative to assess clinical outcomes and optimize care delivery and patient and family outcomes. The aim of this review is to present the potential considerations of implementing long-term clinical follow-up following pediatric critical illness.
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Affiliation(s)
- Debbie A Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Pediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Eagleson K, Campbell M, McAlinden B, Heussler H, Pagel S, Webb KL, Stocker C, Alphonso N, Justo R. Congenital Heart Disease Long-term Improvement in Functional hEalth (CHD LIFE): A partnership programme to improve the long-term functional health of children with congenital heart disease in Queensland. J Paediatr Child Health 2020; 56:1003-1009. [PMID: 32627252 DOI: 10.1111/jpc.14935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
Children who undergo open-heart surgery in the first year of life for congenital heart disease (CHD) are at high-risk for impaired development across multiple domains. International recommendations include systematic periodic developmental surveillance into adolescence and the establishment of long-term follow-up programmes. This article describes the establishment and evolution of the Queensland Paediatric Cardiac Service neurodevelopmental follow-up programme - CHD LIFE (Long-term Improvement in Functional hEalth). Contextualising best practice recommendations to ensure a family-centred and sustainable approach to understand and support the long-term functional health needs of high-risk children with CHD as standard care was needed. We describe the transition from a centralised pilot Programme to the implementation of an integrated statewide approach aimed at delivering consistent high-level standards of care and a platform to evaluate therapeutic interventions.
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Affiliation(s)
- Karen Eagleson
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Miranda Campbell
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Bronagh McAlinden
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Helen Heussler
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Susan Pagel
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Kerri-Lyn Webb
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,Clinical Excellence Division, Queensland Health, Brisbane, Queensland, Australia
| | - Christian Stocker
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nelson Alphonso
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Justo
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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14
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Wojcik MH, Stewart JE, Waisbren SE, Litt JS. Developmental Support for Infants With Genetic Disorders. Pediatrics 2020; 145:peds.2019-0629. [PMID: 32327449 PMCID: PMC7193975 DOI: 10.1542/peds.2019-0629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 01/03/2023] Open
Abstract
As the technical ability for genetic diagnosis continues to improve, an increasing number of diagnoses are made in infancy or as early as the neonatal period. Many of these diagnoses are known to be associated with developmental delay and intellectual disability, features that would not be clinically detectable at the time of diagnosis. Others may be associated with cognitive impairment, but the incidence and severity are yet to be fully described. These neonates and infants with genetic diagnoses therefore represent an emerging group of patients who are at high risk for neurodevelopmental disabilities. Although there are well-established developmental supports for high-risk infants, particularly preterm infants, after discharge from the NICU, programs specifically for infants with genetic diagnoses are rare. And although previous research has demonstrated the positive effect of early developmental interventions on outcomes among preterm infants, the impact of such supports for infants with genetic disorders who may be born term, remains to be understood. We therefore review the literature regarding existing developmental assessment and intervention approaches for children with genetic disorders, evaluating these in the context of current developmental supports postdischarge for preterm infants. Further research into the role of developmental support programs for early assessment and intervention in high-risk neonates diagnosed with rare genetic disorders is needed.
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Affiliation(s)
- Monica H. Wojcik
- Divisions of Newborn Medicine and,Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Jane E. Stewart
- Divisions of Newborn Medicine and,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Susan E. Waisbren
- Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Jonathan S. Litt
- Divisions of Newborn Medicine and,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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Glotzbach KL, Ward JJ, Marietta J, Eckhauser AW, Winter S, Puchalski MD, Miller TA. The Benefits and Bias in Neurodevelopmental Evaluation for Children with Congenital Heart Disease. Pediatr Cardiol 2020; 41:327-333. [PMID: 31865442 DOI: 10.1007/s00246-019-02260-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Neurodevelopmental (ND) impairment is common in children with congenital heart disease (CHD). While routine ND surveillance and evaluation of high-risk patients has become the standard-of-care, capture rate, barriers to referral, and potential patient benefits remain incompletely understood. Electronic data warehouse records from a single center were reviewed to identify all eligible and evaluated patients between July 2015 and December 2017 based on current guidelines for ND screening in CHD. Diagnoses, referring provider, and payor were considered. Potential benefit of the evaluation was defined as receipt of new diagnosis, referral for additional evaluation, or referral for a new service. Contingencies were assessed with Fisher's exact test. In this retrospective, cohort study, of 3434 children identified as eligible for ND evaluation, 135 were evaluated (4%). Appropriate evaluation was affected by diagnostic bias against coarctation of the aorta (CoArc) and favoring hypoplastic left heart syndrome (HLHS) (1.8 vs. 11.9%, p<0.01). Referrals were disproportionally made by a select group of cardiologists, and the rate of ND appointment non-compliance was higher in self-pay compared to insured patients (78% vs 27%, p<0.01). Potential benefit rate was 70-80% amongst individuals with the three most common diagnoses requiring neonatal surgery (CoArc, transposition of the great arteries, and HLHS). Appropriate ND evaluation in CHD is impacted by diagnosis, provider, and insurance status. Potential benefit of ND evaluation is high regardless of diagnosis. Strategies to improve access to ND evaluations and provider understanding of the at-risk population will likely improve longitudinal ND surveillance and clinical benefit.
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Affiliation(s)
- Kristi L Glotzbach
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.
| | - John J Ward
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jennifer Marietta
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Aaron W Eckhauser
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Sarah Winter
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael D Puchalski
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Thomas A Miller
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
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16
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Fourdain S, Caron-Desrochers L, Simard MN, Provost S, Doussau A, Gagnon K, Dagenais L, Presutto É, Prud'homme J, Boudreault-Trudeau A, Constantin IM, Desnous B, Poirier N, Gallagher A. Impacts of an Interdisciplinary Developmental Follow-Up Program on Neurodevelopment in Congenital Heart Disease: The CINC Study. Front Pediatr 2020; 8:539451. [PMID: 33123502 PMCID: PMC7573208 DOI: 10.3389/fped.2020.539451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigates the impact of an early systematic interdisciplinary developmental follow-up and individualized intervention program on the neurodevelopment of children with complex congenital heart disease (CHD) who required cardiac surgery. Study Design: We prospectively enrolled 80 children with CHD: 41 were already followed at our neurocardiac developmental follow-up clinic from the age of 4 months, while 39 were born before the establishment of the program and therefore received standard health care. We conducted cognitive, motor, and behavioral assessments at 3 years of age. We used one-way multivariate analyses of variance to compare the neurodevelopmental outcome of both groups. Results: Between-group analyses revealed a distinct neurodevelopmental profile with clinically significant effect size (P < 0.001, partial η2 = 0.366). Children followed at our clinic demonstrated better receptive language performances (P = 0.048) and tended to show higher scores on visuo-constructive tasks (P = 0.080). Children who received standard health care exhibited greater performances in working memory tasks (P = 0.032). We found no group differences on global intellectual functioning, gross and fine motor skills, and behaviors. Referral rates for specific remedial services were higher in patients followed at our neurocardiac clinic compared to the historical cohort (P < 0.005). Conclusions: Overall, the impact of the developmental follow-up and individualized intervention program on neurodevelopmental outcomes remains subtle. Nevertheless, results, although limited by several factors, point toward an advantage for the children who took part in the program regarding receptive language skills over children who received standard health care. We hypothesize that group differences may be greater with growing age. Further research involving larger cohorts is needed to clearly assess the effectiveness of neurocardiac developmental follow-up programs at school age.
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Affiliation(s)
- Solène Fourdain
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Laura Caron-Desrochers
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Marie-Noëlle Simard
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Sarah Provost
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Karine Gagnon
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Lynn Dagenais
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Émilie Presutto
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Joëlle Prud'homme
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Ioana Medeleine Constantin
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Béatrice Desnous
- Division of Neurology, Department of Pediatrics, La Timone Hospital, Marseille, France
| | - Nancy Poirier
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne Gallagher
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
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17
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Howell HB, Zaccario M, Kazmi SH, Desai P, Sklamberg FE, Mally P. Neurodevelopmental outcomes of children with congenital heart disease: A review. Curr Probl Pediatr Adolesc Health Care 2019; 49:100685. [PMID: 31708366 DOI: 10.1016/j.cppeds.2019.100685] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.
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Affiliation(s)
- Heather B Howell
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Michele Zaccario
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA; Pace University, Department of Psychology, 41 Park Row, New York, NY 10038 USA
| | - Sadaf H Kazmi
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Purnahamsi Desai
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Felice E Sklamberg
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Pradeep Mally
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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18
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Marks KP, Madsen Sjö N, Wilson P. Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review. Dev Med Child Neurol 2019; 61:419-430. [PMID: 30246256 DOI: 10.1111/dmcn.14044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities. METHOD The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis. RESULTS US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial. INTERPRETATION Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts. WHAT THIS PAPER ADDS General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.
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Affiliation(s)
- Kevin P Marks
- Department of Pediatrics, PeaceHealth Medical Group, Eugene, OR, USA
| | - Nina Madsen Sjö
- National Research Centre for Disadvantaged Children and Youth, University College Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, University of Aberdeen, Aberdeen, UK
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19
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Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age. Cardiol Young 2019; 29:100-109. [PMID: 30352635 DOI: 10.1017/s1047951118001622] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early identification of infants with CHD at heightened risk of developmental delays can inform surveillance priorities. This study investigated pre-operative and post-operative neuromotor performance in infants undergoing open-heart surgery, and their developmental status at 6 months of age, to identify risk factors and inform care pathways. METHODS Infants undergoing open-heart surgery before 4 months of age were recruited into a prospective cohort study. Neuromotor performance was assessed pre-operatively and post-operatively using the Test of Infant Motor Performance and Prechtl's Assessment of General Movements. Development was assessed at 6 months of age using the Ages and Stages Questionnaire third edition. Pre-operative and post-operative General Movements performance was compared using McNemar's test and test of infant motor performance z-scores using Wilcoxon's signed rank test. Risk factors for delayed development at 6 months were explored using logistic regression. RESULTS Sixty infants were included in this study. In the 23 (38%) infants. A total of 60 infants were recruited. In the 23 (38%) infants assessed pre-operatively, there was no significant difference between pre- and post-operative performance on the GMs (p=0.63) or TIMP (p=0.28). At discharge, 15 (26%) infants presented with abnormal GMs, and the median TIMP z-score was -0.93 (IQR: -1.4 to -0.69). At 6 months, 28 (52.8%) infants presented with gross motor delay on the ASQ-3, significantly negatively associated with gestational age (p=0.03), length of hospital stay (p=0.04) and discharge TIMP score (p=0.01). CONCLUSIONS Post-operative assessment using the GMs and TIMP may be useful to identify infants requiring individualised care and targeted developmental follow-up. Long-term developmental surveillance beyond 6 months of age is recommended.
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20
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Peterson JK. Supporting Optimal Neurodevelopmental Outcomes in Infants and Children With Congenital Heart Disease. Crit Care Nurse 2018; 38:68-74. [PMID: 29858197 PMCID: PMC6563801 DOI: 10.4037/ccn2018514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Improved survival has led to increased recognition of developmental delays in infants and children with congenital heart disease. Risk factors for developmental delays in congenital heart disease survivors may not be modifiable; therefore, it is important that lifesaving, high-technology critical care interventions be combined with nursing interventions that are also developmentally supportive. Implementing developmental care in a pediatric cardiac intensive care unit requires change implementation strategies and widespread support from all levels of health care professionals. This manuscript reviews developmentally supportive interventions such as massage, developmentally supportive positioning, kangaroo care, cue-based feeding, effective pain/anxiety management, and procedural preparation and identifies strategies to implement developmentally supportive interventions in the care of infants and children with congenital heart disease. Improving developmental support for these infants and children at high risk for developmental delay may improve their outcomes and help promote family-centered care.
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Affiliation(s)
- Jennifer K Peterson
- Jennifer K. Peterson is a PhD candidate at University of California, Irvine, Sue & Bill Gross School of Nursing, as well as the Children's Heart Institute Clinical Program Director at Miller Children's and Women's Hospital in Long Beach, California.
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21
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Brosig CL, Bear L, Allen S, Simpson P, Zhang L, Frommelt M, Mussatto KA. Neurodevelopmental outcomes at 2 and 4 years in children with congenital heart disease. CONGENIT HEART DIS 2018; 13:700-705. [PMID: 30191663 DOI: 10.1111/chd.12632] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/29/2018] [Accepted: 05/04/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Children with congenital heart disease (CHD) are at risk for neurodevelopmental (ND) delays. The purpose of this study is to compare the ND testing results of children with CHD at 2 and 4 years of age and determine if rates of ND delays change over time. METHODS Children with CHD completed the Bayley Scales of Infant Development-III (BSID-III) at 2 years of age, and standardized neuropsychological measures at 4 years. Scores were compared with test norms and were classified as: average (within one SD of test mean); at risk (1-2 SDs from the test mean); and delayed (>2 SD from test mean). Pearson correlations and McNemar's exact tests were performed to determine the relationship between test scores at the two times of assessment. RESULTS Sixty-four patients completed evaluations at 24 ± 3 months of age and 4 years of age. BSID-III cognitive and fine motor scores were correlated with preschool IQ and fine motor scores, r = .75 to .87, P < .0001. Agreement in score categories was 79% for cognitive and 61% for fine motor. More patients had at risk or delayed scores at age 4 vs age 2 (P ≤ .01). CONCLUSION(S) Despite significant correlations between 2- and 4-year-old test scores, many patients who scored in the average range at age 2 showed deficits at age 4. BSID-III scores at age 2 may underestimate delays. Therefore, longitudinal ND assessment is recommended.
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Affiliation(s)
- Cheryl L Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Laurel Bear
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Sydney Allen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michele Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen A Mussatto
- Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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22
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Ubeda Tikkanen A, Nathan M, Sleeper LA, Flavin M, Lewis A, Nimec D, Mayer JE, Del Nido P. Predictors of Postoperative Rehabilitation Therapy Following Congenital Heart Surgery. J Am Heart Assoc 2018; 7:JAHA.117.008094. [PMID: 29754124 PMCID: PMC6015299 DOI: 10.1161/jaha.117.008094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Patients with congenital heart disease are at risk of motor, cognitive, speech, and feeding difficulties after cardiac surgery. Rehabilitation therapy could improve functional outcomes in this population if applied in the acute postcardiac surgical in‐hospital stay. However, information on the types of acute postcardiac surgery therapy needs in children is scarce. Our goal was to describe rehabilitation therapy following congenital heart surgery and pre/intraoperative factors associated with need for therapy. Methods and Results This is a retrospective cohort study of patients <18 years undergoing heart surgery at our center from January 1, 2013 to January 31, 2015. Demographic, and pre‐, intra‐, and postoperative clinical and rehabilitation therapy (physical, occupational, speech, feeding therapy, and neurodevelopment intervention) data were collected. Need for rehabilitation therapy in the acute postoperative period, particularly following palliative repair, was the outcome variable in a multivariable logistic regression model to identify independent pre‐ and intraoperative factors associated with therapy. A total of 586 out of 1415 (41%) subjects received rehabilitation therapy postsurgery. Certain subgroups had increased rehabilitation therapy use such as neonates (80%). On multivariable analysis, palliative repair, prematurity, genetic syndrome, presurgical hospital stay of more than 1 day, and prolonged cardiopulmonary bypass time were independently associated with rehabilitation therapy. Conclusions Nearly half of patients who underwent post–congenital heart surgery received rehabilitation therapy. Frequency of use and types of therapy vary according to patient characteristics; however, certain pre‐ and intraoperative factors are associated with need for rehabilitation therapy, and may aid decision‐making for appropriate resource allocation.
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Affiliation(s)
- Ana Ubeda Tikkanen
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA .,Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Lynn A Sleeper
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Marisa Flavin
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
| | - Ana Lewis
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
| | - Donna Nimec
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Pedro Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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23
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Healthcare Disparities in Outcomes of a Metropolitan Congenital Heart Surgery Center: The Effect of Clinical and Socioeconomic Factors. J Racial Ethn Health Disparities 2017; 5:410-421. [PMID: 28849382 DOI: 10.1007/s40615-017-0384-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study is to identify the impact of demographic, socioeconomic, and clinical factors on congenital heart surgery outcomes. STUDY DESIGN This retrospective cohort study included 234 congenital heart surgery patients from 2011 through 2015, in a racially/ethnically diverse metropolitan children's hospital. Outcomes included length of stay (LOS), age at first echocardiogram, length of mechanical ventilation, and incidence of complications. RESULTS Compared to others, black children underwent their first echocardiogram at a later age (median 23 versus 2 days, p = 0.014) and were more likely to be diagnosed with congenital heart disease in the emergency room (p = 0.026). Hispanic children were more likely to have major non-cardiac congenital anomalies (p = 0.045). Increased LOS during elective admissions was associated with higher surgical complexity (STAT category 4 and 5 Estimate 3.905 days, p = 0.001), compared to STAT category 1, and number of complications (Estimate = 2.306 days per complication, p < 0.001). Increased LOS in non-elective admissions was associated with the number of complex chronic conditions (Estimate = 15.446 days, p = 0.045) and the number of complications (Estimate = 11.591 days per complication, p < 0.001). However, in multivariate analysis, race and ethnicity was not associated with increased LOS or age at first echocardiogram. CONCLUSION In this diverse setting, race/ethnicity was not associated with increased LOS, age at first echocardiogram, length of ventilation, or complications. Surgical complexity, chronic conditions, and complications were associated with increased LOS. We discuss some interventions to reduce disparities in congenital heart surgery outcomes.
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