Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury.
Raymond Stegeman, Maaike C A Sprong, Johannes M P J Breur and 7 others
PMID 34416027WHAT IT FOUND
After neonatal heart surgery, smaller cortical grey matter and cerebellum volumes were linked to poorer fine motor scores, and white matter injury to lower gross motor scores.
Stroke affecting motor pathways showed early abnormalities, but only five infants.
Key findings
01Higher cortical grey matter volume was associated with better fine motor scores at 9 months, and higher cerebellum volume was associated with better fine motor scores at 9 and 18 months.
02Infants with neonatal white matter injury had lower gross motor scores at 9 months and were more likely to have gross motor scores at or below one standard deviation below average.
03Five infants had arterial ischaemic stroke involving the corticospinal tract; they often had abnormal general movements, absent fidgety movements, abnormal tone, and low motor scores early, but only three were testable at 18 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 51 infants were analysed, and the stroke-with-corticospinal-tract group had only five infants, so small differences could be chance. The authors did not adjust p-values for multiple testing, so some significant associations may not be reliable. Confidence intervals were wide, and the authors state the clinical relevance of statistically significant results is unclear. This was an observational study, so it shows associations, not that brain volume, brain injury, or surgery caused motor delay. Infants born preterm or with genetic disorders were excluded, so findings may not apply to those groups. Two infants with stroke involving the corticospinal tract were too unwell to test at 18 months. Later motor data are incomplete for that group. Potential clinical factors between postoperative MRI and motor testing may have been missed. Follow-up was only to 18 months, and motor outcomes may not be stable over time.
Declared interests
The authors declared no conflicts of interest. The supplied article text does not report a funder or sponsor role.
The easy way to misread this
Do not use these MRI findings to predict an individual infant's outcome or to choose a specific therapy. The study included 51 infants, the corticospinal-tract stroke group had only five infants, and the authors state the clinical relevance of significant results is unclear because confidence intervals are wide.