Early motor behavior reflects neurologic involvement in infants with congenital heart disease.

BACKGROUND: Infants with congenital heart disease (CHD) demonstrate early differences in brain development and are at increased likelihood for neurodevelopmental delays. Spontaneous motor behavior reflects early neurologic function but remains poorly characterized in CHD. OBJECTIVE: To compare spontaneous motor behavior between infants with CHD and typically developing infants using Motor Optimality Score-Revised (MOS-R) and to examine clinical factors associated with motor performance in infants with CHD. METHODS: In this retrospective observational study, 202 infants with CHD and 49 typically developing infants underwent video-based assessment of spontaneous movements between 10 and 20 weeks corrected age. MOS-R scores and individual movement characteristics were compared between groups. Associations between MOS-R and clinical factors were evaluated using multivariable linear regression. RESULTS: Infants with CHD had lower MOS-R scores compared to typically developing infants (median 23 [IQR 20-25] vs 26 [24-26], p < 0.001). They were less likely to demonstrate normal fidgety movements, hand-to-hand and foot-to-foot behaviors, and sustained antigravity limb movements. Within the CHD cohort, multivariable analysis showed moderate to severe neuroimaging abnormalities (β -2.4, 95% CI -4.2 to -0.48), genetic syndromes (β -2.7, 95% CI -4.2 to -1.1), and sedation at assessment (β -4.4, 95% CI -6.0 to -2.8) were associated with lower MOS-R scores, whereas cardiac physiology and intervention type were not. CONCLUSIONS: Early motor differences are evident in infants with CHD and were more closely associated with neurologic and genetic factors than with cardiac diagnosis or treatment characteristics. Spontaneous motor assessment using MOS-R may support early identification of neurologic involvement.