Physical Inactivity in Very Young Children with Congenital Heart Defects Cannot be Explained by Motor Development, Hospitalization or Cardiopulmonary Bypass Exposure.

Background: Motor development delays among children with complex congenital heart defects have been attributed to cardiopulmonary bypass exposure. In healthy children, motor skill deficits are associated with sedentary lifestyles. This study evaluated the associations between motor development and physical activity among young children with simple and complex heart defects. Methods: Children 12 to 47 months were recruited through two tertiary pediatric cardiac clinics. Assessments were the Peabody Motor Development Scale and daily physical activity via omnidirectional accelerometer. Children ≥36 months also completed the Test of Gross Motor Development--2. Medical chart review determined total days of hospitalization and cardiopulmonary bypass exposure. Results: 141 toddlers (75 males (53%)), varying from 12 to 51 months in age (mean 30.9 ± 11.0 mos) were enrolled in 5 study groups: innocent murmur (n=30), congenital heart defect (CHD) not requiring treatment (n=40), CHD repaired without surgery (N=20), surgical repair of CHD without cardiopulmonary bypass (n=15), or surgical CHD repair with bypass (n=36). Peabody object manipulation scores were significantly below (95% CI of difference: -0.4, -1.1; p<.001) and visual motor scores above (95% CI of difference: 0.1, 1.1; p=0.02) normative values. TGMD locomotor (95% CI of difference: 0.7, 2.3; p<0.001) and object manipulation (95% CI of difference: 0.4, 1.8; p=0.001) scores were above published norms (n=58). Children performed 135 ± 48 minutes of physical activity, any intensity, daily (range: 8 to 289 mins). Visual motor scores were higher in CHD without repair and surgery without bypass groups (Model R2 = 0.32, p<.001). No other between group differences occurred. No significant associations occurred between hospital length of stay (none, ≤ 10 days, > 10 days), daily physical activity and motor development. Discussion: Children treated in the current surgical era are not at risk for motor development delays from cardiopulmonary bypass exposure or extended hospital stays. Overall measures of motor development are similar to published norms. Low object manipulation scores among all study participants (Peabody) were not apparent when older children were assessed on more complex motor skills (TGMD-2). Young children with CHD have the skills needed for physical activity. The reason for their limited participation remains unknown. [ABSTRACT FROM AUTHOR]