Assistant Professor University of Chicago University of Chicago Chicago, Illinois, United States
Background: Infants who survive prematurity and other critical illnesses but continue to require invasive mechanical ventilation (IMV) assistance are at high risk of developmental delays and disabilities. Need for tracheostomy may limit essential early speech opportunities. Long hospitalizations increase developmental vulnerabilities through delayed and disrupted early childhood experiences. The developmental profiles, trajectories, and protective or confounding factors for children with IMV are largely unknown.
Objective: To determine the early childhood developmental profiles of a pilot cohort of children with new IMV transitioning home from the hospital.
Design/Methods: Participants were a consecutive series of children with IMV assistance. The visits occurred in family homes one month after hospital discharge. Testing was completed to determine functioning within motoric, cognitive, and communicative domains by a Developmental and Behavioral Pediatrician using 1) the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) which compares language and non-language related problem-solving skills to aid in the diagnosis of developmental delay and disability and 2) the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) which measures the child’s functioning in daily activities, mobility and social/cognitive skills.
Results: Fourteen children were average(range) 14(6-30) months old, 50% male, 36% Non-Hispanic White, 36% Non-Hispanic Black, and 21% Hispanic. Nine (64%) children were survivors of prematurity. All children had a tracheostomy, ventilator, and feeding tube. Children had average (range) of full-scale developmental quotients (DQ) of 62 (19-95.5), with CAT DQ 64.1 (14-113) and CLAMS DQ 63 (24-108). In the area of mobility, 11 (79%) functioned at below the 5%ile. In the area of social cognition, 4 (29%) performed below the 5%ile and 7 (50%) performed 5-25%ile. Conclusion(s): Children with IMV display a wide range of developmental abilities with a majority experiencing significant delays in motor, communicative, and adaptive functioning. The degree and cross-domain deficits highlight the need for therapeutic strategies for children with technology assistance. Further investigations with this pilot cohort will describe their range of functional performance and repeat evaluations over time will describe developmental progress and stagnation in order to understand the factors which promote developmental resiliency.
Authors/Institutions: Sarah A. Sobotka, University of Chicago, Chicago, Illinois, United States; Emma Lynch, University of Chicago, Chicago, Illinois, United States; Robert J. Graham, Boston Children's Hospital, Boston, Massachusetts, United States; Michael E. Msall, UChicago Comer Children's Hospital, Chicago, Illinois, United States
