Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age

Background: Early identification of infants with CHD at heightened risk of developmental delays can inform surveillance priorities. This study investigated pre-operative and predischarge 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 predischarge 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 pre-discharge 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: A total of 60 infants were recruited. In the 23 (38%) infants assessed pre-operatively, there was no significant difference between pre-operative and pre-discharge 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 <= 0.01) and discharge TIMP score (p <= 0.01). Conclusions: Pre-discharge 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.