title: Infant Motor Skills After a Cardiac Operation: The Need for Developmental Monitoring and Care.
abstract: BACKGROUND
  Neurodevelopmental dysfunction is increasingly recognized as a common outcome of congenital heart defects and their treatment in infancy. The effects of the intensive care unit (ICU) experience and environment on these infants are unknown and potentially modifiable, but no validated metric is available for objective evaluation of early motor impairments in the ICU/hospital setting. The purpose of this study was to characterize the motor status of hospitalized infants after cardiac operations, including the development and field-testing of the Congenital Heart Assessment of Sensory and Motor Status (CHASMS) metric.
  
  
  METHODS
  CHASMS item generation was based on review of the literature, focused interviews with parents, and expert consensus. A nurse administered CHASMS to 100 infants aged younger than 10 months old undergoing cardiac operations. Preoperative and postoperative CHASMS scores were compared, and associations between CHASMS scores and patient characteristics were examined. Physical therapists assessed neuromotor skills by using the Test of Infant Motor Performance or the Alberta Infant Motor Scales for correlation with CHASMS scores.
  
  
  RESULTS
  CHASMS gross motor scores declined postoperatively in 64% (25 of 39). Lower CHASMS scores, after adjusting for age, were associated with longer duration of mechanical ventilation (p < 0.001) and ICU length of stay (p = 0.001). Gross motor CHASMS scores were significantly correlated with Test of Infant Motor Performance (r = 0.70, p < 0.001) and Alberta Infant Motor Scales scores (r = 0.88, p < 0.001).
  
  
  CONCLUSIONS
  Motor impairments in infants after cardiac operations are common and may be exacerbated by longer intubation and prolonged exposure to the ICU environment. The feasibility, reliability, and validity of CHASMS were supported for the evaluation of motor skills in this at-risk population.
authors.affiliation: Department of Cardiac Surgery, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan. Electronic address: karenu@med.umich.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Uzark
authors.affiliation: Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Janet
authors.initials: J
authors.lastname: Donohue
authors.affiliation: Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Cardiac Surgery, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Romano
mesh_terms: D006348:Cardiac Surgical Procedures; D002657:Child Development / Q000502:physiology*; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008991:Monitoring, Physiologic / Q000379:methods*; D009048:Motor Skills / Q000502:physiology*; D019957:Motor Skills Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D009483:Neuropsychological Tests; D011184:Postoperative Period; D011379:Prognosis; D015203:Reproducibility of Results; D013997:Time Factors