Majnemer Annette, Limperopoulos Catherine, Shevell Michael, Rosenblatt Bernard, Rohlicek Charles, Tchervenkov Christo
School of Physical & Occupational Therapy, Department of Neurology & Neurosurgery, McGill University, Toronto, Ontario, Canada.
J Pediatr. 2006 Jan;148(1):72-7. doi: 10.1016/j.jpeds.2005.08.036.
Increased survival in infants with complex congenital heart defects (CHDs) has resulted in greater focus on morbidity. This prospective study was conducted to investigate whether or not neuromotor impairments evident acutely persist long-term.
A total of 94 infants with CHD were reassessed at school entry (age 64.2 +/- 11.3 months) by blinded examiners using the Peabody Developmental Motor Scale and neurologic examination.
Neurologic abnormalities were noted in 28.4% of the subjects, with hypotonia and developmental delay most commonly observed. Microcephaly was documented in 15.4% of subjects, with head circumference >50th percentile in only 14.1%. Mean gross and fine motor quotients were shifted downward (82.7 +/- 12.3 and 86.2 +/- 16.3, respectively), and gross and fine motor delays were prevalent (49.4% and 39.0%, respectively). Severe disability was rare (<5%). Predictors of neurologic impairment included type of surgery (palliative/corrective), abnormal postoperative neurologic examination, and presence of microcephaly at initial surgery. Gross motor delay was more likely if palliated. Deep hypothermic circulatory arrest time, palliative surgery, microcephaly, and number of hospitalizations were associated with fine motor delay.
Neurologic impairments and motor delay are common in survivors of open-heart surgery, persisting to age of school entry. Early indicators of medical complications and acute neurologic compromise are associated with increased risk. Early identification and intervention may optimize performance in those at risk.
复杂先天性心脏病（CHD）患儿存活率的提高使得人们更加关注其发病率。本前瞻性研究旨在调查急性明显的神经运动障碍是否会长期持续存在。
共有94例CHD患儿在入学时（年龄64.2±11.3个月）由盲法检查人员使用皮博迪发育运动量表和神经系统检查进行重新评估。
28.4%的受试者存在神经异常，最常见的是肌张力减退和发育迟缓。15.4%的受试者记录有小头畸形，头围大于第50百分位数的仅占14.1%。平均粗大运动商和精细运动商均向下偏移（分别为82.7±12.3和86.2±16.3），粗大运动和精细运动延迟普遍存在（分别为49.4%和39.0%）。严重残疾很少见（<5%）。神经功能损害的预测因素包括手术类型（姑息性/矫正性）、术后神经系统检查异常以及初次手术时存在小头畸形。如果是姑息性手术，粗大运动延迟的可能性更大。深低温停循环时间、姑息性手术、小头畸形和住院次数与精细运动延迟有关。
心脏直视手术幸存者中神经功能损害和运动延迟很常见，持续到入学年龄。医疗并发症和急性神经功能损害的早期指标与风险增加有关。早期识别和干预可能会优化高危人群的表现。
