1141 - Prevalence and Documentation of Hypotonia in Infants with Congenital Heart Disease

Objectives: Infants with Congenital Heart Disease (CHD) have improved survival rates due to advances in medical care; however, they continue to face developmental delays, including gross motor delays. Specific contributors to gross motor delays are unclear, with hypotonia suspected as a contributing factor. However, hypotonia prevalence in this population remains poorly documented and screening methods are inconsistent and vary widely. This study aimed to assess the prevalence of hypotonia in infants with CHD and explore its association with subjective provider documentation.

Design: This study utilized a single-center retrospective chart review approved by the Institutional Review Board. Infants aged 6 to 10 months with CHD from an early detection database at a level IV NICU follow-up clinic were included, gathering preliminary clinical data over 24 months. Data analyzed included Hammersmith Infant Neurological Exam (HINE) scores, demographics, muscle tone descriptors, and medical documentation.

Results: Twenty-five infants met the inclusion criteria (48% male, 52% female). Thirteen infants had documented HINE scores available. Twenty-two of 25 infants had hypotonia noted during any medical visit and 16 during the NICU follow-up clinic visit. Patients with hypotonia documentation displayed a median Global HINE score of 9.5 points lower (median HINE of 66.5 for those with documented hypotonia, and 76 without documented hypotonia). The most common hypotonia indicators encompassed hip adductors, popliteal angles, impaired sucking, and swallowing.

Conclusions: The majority of infants (88%) attending a level IV NICU Follow-Up Clinic with CHD had documented hypotonia. Infants documented with hypotonia showed lower global HINE scores, demonstrating an association between standardized HINE scores and subjective documentation. This study suggests that a comprehensive approach, encompassing both standardized and descriptive assessments, may be useful in evaluating hypotonia. Early screening may allow for optimal, early intervention to potentially influence developmental outcomes for this vulnerable population.