430 - Evaluating General Movement Assessments in Infants with Congenital Heart Disease Requiring Surgical Repair

Publication Number: 3415.430

Teryn Igawa, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Sandra Luz. espinosa, UCLA Mattel Childrens Hospital, Pasadena, CA, United States; Samantha Bell-Rushakoff, Lincoln Community Health Center, Durham, NC, United States; Sai Iyer, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Sonia Voleti, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Kalpashri Kesavan, University of California, LOS ANGELES, CA, United States

Background: Congenital heart disease (CHD) is the most prevalent birth defect in the United States. Improvements in perinatal care have increased survival rates to 80-90%. However, infants with CHD remain at high risk for developmental delays. General movements (GMs) are spontaneous movements that when assessed by trained providers, can identify motor deficits early, prompting referral to early intervention (EI). To date, only 4 studies utilizing GM assessments (GMAs) have been published in the CHD population, and they demonstrated high rates of abnormal GMAs.

Objective: The primary aim of this study is to characterize writhing and fidgety GMAs of infants with CHD. The secondary aim is to assess risk factors for abnormal GMAs in infants with CHD.

Design/Methods: This study includes infants at UCLA who were < 6 months old with surgically repaired CHD and at least 1 GMA from 2018-2024. GMs were analyzed by providers with GMA training. GMs have two distinct stages: birth to 46 weeks corrected gestational age (cGA) is the writhing stage and 3 to 6 months cGA is the fidgety stage. Writhing GMAs were classified as normal writhing (NW), poor repertoire (PR), or cramped synchronous (CS). Fidgety GMAs were classified as normal fidgety (NF), absent fidgety (AbsF), or abnormal fidgety (AbnF). GMAs in the CHD group were compared to a control group of extremely-low birth weight (ELBW) infants. Patient demographics and GMA data were collected by chart review and compared using t-tests or ANOVA tests with p< 0.05 considered statistically significant.

Results: Of the 303 infants who underwent cardiac surgery, 72 infants had at least 1 GMA performed, of which 55 had a writhing GMA and 33 had a fidgety GMA. In the ELBW cohort, 45 infants had at least 1 GMA, of which 37 had a writhing GMA and 35 had a fidgety GMA. In the writhing stage, GMA classification was different between groups (CHD vs. ELBW 57.4% vs. 40.5% NW, 40.7% vs. 32.4% PR, 1.9% vs. 29% CS, overall p=0.001). In the fidgety stage, the rate of abnormal GMAs in the CHD group GMAs was similar to the ELBW group (84.8% vs. 63.9% NF, 0% vs. 11.1% AbnF, 15.2% vs. 25.0% AbsF, overall p=0.063). Within the CHD group, the need for anti-epileptic medications (NF vs. AbsF 3.6% vs. 60%, p=0.007) and the presence of any brain anomaly (25% vs. 80%, p=0.032) was associated with absent fidgety GMAs.

Conclusion(s): Infants with surgically-repaired CHD have high rates of abnormal GMAs, with similar rates of absent fidgety GMAs compared to ELBW infants. GMA should be incorporated in the developmental assessment of infants with CHD to facilitate early diagnosis and timely referral to EI.

Table 1
Summary of infant characteristics

Figure 1
Writhing GMA results ELBW group vs. CHD group

Figure 2
Fidgety GMA results ELBW group vs. CHD group