Abstract 3279: Gross Motor Delay is Common Early after the Norwood Procedure Even in the Presence of a Normal Brain MRI
Background Developmental delays are common in infants with hypoplastic left heart syndrome (HLHS). These infants have been shown to have a high incidence of ischemic lesions on brain MRI before and after Norwood surgery, although the clinical significance of these lesions is unknown. We performed neurodevelopmental (ND) testing in Norwood patients who had previously undergone MRI evaluation.
Methods Fourteen infants with HLHS who had brain MRI performed before and after Norwood palliation were evaluated by a neuropsychologist. The Vineland Adaptive Behavior Scales (VABS) parent interview assesses early communication, daily living, socialization, and motor skills. The Mullen Scales of Early Learning (MSEL) use interactive “toys” to measure visual perception, communication, and fine and gross motor abilities. All patients were evaluated prior to stage II operation (3–7mo) and 10 infants had repeat evaluation at 1 year (11–17mo).
Results On average, HLHS infants scored in the normal range on the VABS in communication, daily living, and socialization (means = 95–101) but exhibited mild yet significant motor delay at the pre-stage II visit (mean score 89 ± 4) and at 1 yr follow-up (88 ± 7), p< .01 compared to norms of 100 ± 15. Mean composite MSEL was in the low-average range at both time points, largely attributable to low gross motor scores (means 35 ± 8 and 29 ± 11, p< .01 compared to norms of 50 ± 10). All but one infant had significant delay in gross motor development at both visits. There was no significant difference in scores between infants with normal brain MRI studies and those with pre- or post-operative MRI ischemia. Pre-stage II scores correlated well with scores at 1 year follow-up (r2=0.872)
Conclusions Infants with HLHS are at risk for ND delay after the Norwood procedure. Early gross motor delay occurs in most infants, even in the presence of a normal brain MRI. ND follow-up and intervention is warranted in these infants.