Early motor development and exercise capacity association in children with a congenital heart disease: An explorative study
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Background: Several studies report a high prevalence of abnormal cerebral findings in newborns with a congenital heart disease (CHD), frequently resulting in delayed motor development. Additionally, reduced exercise capacity is often observed in children with CHD and both motor development and exercise capacity decline with increased severity. As peak exercise capacity is a strong predictor for mortality, early identification is of great clinical value. However, assessment of exercise capacity can only be objectified by exercise testing from approximately the age of 6. Motor development outcomes however, seems to be an independent predictor of exercise capacity and may be used as an early predictor of decreased exercise capacity. Aim: The primary aim of this study is to determine whether there is an association between motor development at the age of 3.5 and exercise capacity between 6 and 7 years. Additionally, association between motor development and exercise capacity between 6 and 7 will be determined. Motor development change over time will also be described. Lastly, we will explore whether exercise capacity is influenced by clinical characteristics. Methods: Pediatric patients with various types of CHD from the Wilhelmina Children’s Hospital in Utrecht were recruited. Motor development was tested with the MABC-2 at 3.5 years and BOT-2 and exercise capacity was assessed between 6 to 7 years, respectively. Correlations were determined to assess associations and univariate analysis was applied to determine the influence of clinical characteristics on exercise capacity. Results: Thirty-five patients participated in this study. A weak correlation was found between motor development at 3.5 years and peak exercise between 6 and 7 years. Correlation between motor development and peak exercise capacity between 6 and 7 years was moderate. Motor development change over time was high. No clinical characteristics were significantly related to peak exercise capacity. Conclusion and key findings: Only a weak correlation was found, with no characteristics related to peak exercise capacity. Motor development was highly variable over the course of three years and consequently extensive follow-up should be part of usual care in patients with CHD. Future research should examine the association in a larger cohort of patients with CHD.