Risk of Developmental Coordination Disorder in 8- and 9-Year-Olds Following Newborn Cardiac and Non–Cardiac Surgery : Pediatric Physical Therapy

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RESEARCH REPORTS

Risk of Developmental Coordination Disorder in 8- and 9-Year-Olds Following Newborn Cardiac and Non–Cardiac Surgery

Fairbairn, Natalie MPH/MHM, OT; Badawi, Nadia MD, PhD; Galea, Claire MEpi; Hodge, Antoinette PHD; Loughran-Fowlds, Alison MD, PhD; Novak, Iona OT, PhD

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Pediatric Physical Therapy 35(1):p 49-55, January 2023. | DOI: 10.1097/PEP.0000000000000974
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Abstract

INTRODUCTION

The increased risks of developmental coordination disorder (DCD) are well recognized in the preterm and low birth weight populations.1,2 Children who have undergone neonatal cardiac surgery (CS) or non–cardiac surgery (NCS) experience early delays in cognitive, language, and motor development.3,4 They require long-term follow-up due to increased risks of ongoing neurodevelopmental difficulties with executive functioning, academic performance, and motor skill delays when compared with their peers.5,6 The risk of DCD in the surgical population, however, is unknown and has not been reported in the literature.

Developmental coordination disorder is a condition that is characterized by difficulties with motor performance and coordination. A formal diagnosis is made by a medical practitioner or a psychologist using the Diagnostic and Statistical Manual of Mental Disorders (Fifth edition [DSM-V])7; diagnostic criteria for DCD include the following:

  1. The acquisition and execution of coordinated motor skills are substantially below that expected, given the individual's chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (eg, dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (eg, catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports).
  2. The motor skills deficit in criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (eg, self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play.
  3. Onset of symptoms is in the early developmental period.
  4. The motor skills deficits are not better explained by intellectual disability (intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (eg, cerebral palsy, muscular dystrophy, degenerative disorder).

Estimates about the prevalence rates of DCD in the school-aged population vary in the literature; however, they are most frequently reported as between 5% and 6%.8

The broader effect of DCD on a child's academic, social, and emotional well-being is significant and without early intervention, difficulties often persist into adolescence and adulthood.9 It has been reported that more than 70% of children who have DCD continue to have problems into adolescence and adulthood, including more emotional difficulties, depressive symptoms, and more difficulties with social communication than their peers.9

Funding and length of follow-up remain inconsistent and are often only short term for this vulnerable group of children, hampering early diagnosis and intervention that might improve outcomes. Despite the research on the increased prevalence of DCD among other high-risk populations10–12 and the significant effect on children and families,8 there has been no research to date on the occurrence of DCD among the surgical population. The aim of this research was to investigate the risk of DCD for children who had undergone newborn CS and NCS and to elucidate the profile of the associated emotional and behavioral difficulties in the surgical population.

METHODS

Study Design

Prospective longitudinal cohort study.

Participants

There were 3 groups of participants: cardiac surgical (CS), non–cardiac surgical (NCS), and participants who did not have undergone surgery. The CS and NCS groups consisted of infants who had undergone early major surgery, which was defined as the opening of a body cavity, within the first 90 days of life. For the NCS group, this included conditions such as pyloric stenosis, tracheoesophageal fistula, abdominal wall defects, congenital diaphragmatic hernia and Hirschsprung disease. For the CS group, this included infants who had disorders such as transposition of the great arteries, truncus arteriosus, ventricular septal defect, atrioventricular septal defect, hyperplastic left-sided heart syndrome, tetralogy of Fallot, and pulmonary atresia.

Infants were initially recruited from surgical neonatal intensive care units within New South Wales, Australia, and controls were recruited from colocated maternity units between August 2006 and December 2008. Children were excluded from initial enrolment if they required neurosurgery, only had patent ductus ligation, if their parents or caregiver were unable to speak or read English, if the infant had any chromosomal abnormality, or if the family lived overseas. Ethics approval (HREC/14/SCHN/54) and informed consent from parents/caregiver were obtained.

All children were enrolled in the Development After Infant Surgery (Daisy) study. Children were seen longitudinally at 3 time points: at 1, 3, and 8 or 9 years of age. Outcomes have been previously reported.13,14 A total of 257 children were enrolled prospectively for a range of assessments at either 8 or 9 years of age, which were completed between March 2015 and July 2019.

Children were excluded from analysis if they were born less than 37 weeks of gestation (n = 2) as children who are born late preterm are known to have increased risk of DCD and other neurodevelopmental difficulties.12 Children were also excluded from analysis if they had a diagnosis of cerebral palsy (n = 3), or an intellectual disability (n = 12), as measured as less than 70 on the Wechsler Abbreviated Scale of Intelligence—Second Edition (WASI-II)15 in line with DSM-V criteria for DCD (criteria D).16 This included 7 boys and 12 girl who had undergone CS, 2 boys and 1 girl who had undergone NCS, and 1 boy who was in the control group. Children were also excluded if they had undergone both CS and NCS (n = 3), or if there were incomplete results (n = 9).

Diagnostic Terminology

Throughout this study, we used the more conservative diagnostic terminology “at risk of DCD” rather than DCD because our study did not include a functional measure and therefore insufficient data existed to meet all DSM-V diagnostic criteria as previously discussed.

Measurements

The Movement Assessment Battery for Children (Second Edition) (MABC-2), the Wechsler Abbreviated Scale of Intelligence—Second Edition (WASI-II), the Child Behavior Checklist (CBCL) (parent and teacher reported), and the Behavior Rating Inventory of Executive Function (BRIEF) (parent and teacher reported) were completed as part of a range of assessments at 8 to 9 years of age. Assessments were completed as per their standardized protocols at The Children's Hospital at Westmead, the child's school, or at home, whichever was preferred by the parents. The MABC-2, WASI-II, and parent-reported CBCL and BRIEF were completed on the same day. The teacher-reported CBCL and BRIEF assessments were completed shortly following the other assessments. Assessors were masked to the child's category and diagnosis throughout assessment and scoring.

Movement Assessment Battery for Children (Second Edition)

The MABC-2 is a standardized assessment that measures the fine and gross motor performance in 3 domains: manual dexterity, aiming and catching, and balance in children aged 3 to 16 years. A total standard score and percentile ranks are obtained from normative data.8,17 The MABC-2 was administered and scored by an experienced occupational therapist or a physical therapist.

The Wechsler Abbreviated Scale of Intelligence—Second Edition

The WASI-II is a standardized, norm-referenced assessment that measures the cognitive ability of people aged 6 years and older. It consists of 4 subtests, including vocabulary, similarities, block design, and matrix reasoning. A verbal comprehension Index and a performance intelligent quotient are obtained. The results from the 4 subtests are combined to form the Full-Scale Intelligence Quotient (FSIQ-4).15 The WASI-II was administered by an experienced neuropsychology intern.

Behavior Rating Inventory of Executive Function

The BRIEF is a parent- and teacher-reported questionnaire that measures executive function and behavioral regulation for children aged 5 to 18 years. It measures concepts such as inhibit, shift emotional control, initiate, planning and organization, monitor, inhibition, and working memory.18

Child Behavior Checklist

The CBCL is a parent- and teacher-reported questionnaire assessing behavior and emotional well-being for children and adolescents aged 6 to 18 years. The CBCL measures concepts including thought problems, anxiety/depression, withdrawn and social problems, rule-breaking behaviors, aggressive behaviors, attention problems, and somatic complaints.19

Statistical Analysis

Scaled scores on the MABC-2 were used for the analysis. Data were checked for normality by visual inspection of Q plots, box plots, Shapiro-Wilk test, and investigation of skewness and kurtosis. One-way analysis of variance was conducted to assess differences between 8- and 9-year-old children for subtests and total scaled scores, and independent samples t tests were conducted to compare the means between these 2 age groups.

Unadjusted odds ratios and independent samples t test were conducted to compare BRIEF and CBCL and MABC-2 means for those who were at an increased risk of DCD compared with those who were not.

There was an inadequate sample size for statistical subgroup analysis for children who had undergone either open-heart surgery or bypass.

Significance was set at P value of less than .05. Analysis was conducted using SPSS (V.24) and STATA (STATA, Version 14, StataCorp, College Station, Texas).

RESULTS

Complete assessments were available for 210 participants (130 boys and 80 girls), which included 62 participants who had undergone CS, 64 participants who had undergone NCS, and 84 participants in the control group (Table 1). Data normality assumptions were met for CS, NCS, and control groups. One-way analysis of variance found no differences between 8- and 9-year outcomes; therefore, results of 8- and 9-year-olds were combined for analysis.

TABLE 1 - Participant Characteristics
Category
Cardiac Surgery
(n = 62)
Non–Cardiac Surgery
(n = 64)
Controls
(n = 84)
Gender
Male 39 40 51
Female 23 24 33
GA, mean (SD), wk 39.2 (1.3) 38.9 (1.3) 39.4 (1.2)
Age at assessment years, mean (SD) 9.0 (0.5) 8.8 (1.3) 9.1 (0.6)
Abbreviation: GA, gestational age.

Movement Difficulties

Children in the CS group had significantly poorer total mean standard and manual dexterity and balance scores on the MABC-2 compared with the control group. Children who had undergone CS performed worse on balance tasks compared with children who had undergone NCS. There were no statistically significant differences between children who had undergone NCS and controls for any of the motor subtests on the MABC-2 (Table 2).

TABLE 2 - Between-Group Mean Differences for Total Standard Scores and Total Subtests on the Movement Assessment Battery for Children (Second Edition)
Cardiac Surgery (62) Mean (SD) Non–Cardiac Surgery (64) Mean (SD) Mean Difference Between Cardiac Surgery and Non–Cardiac Surgery Cardiac (62) Mean (SD) Control (84) Mean (SD) Mean Difference Between Cardiac And Control Non–Cardiac Surgery (64) Mean (SD) Control (84) Mean (SD) Mean Difference Between Non–Cardiac Surgery and Control
Mean (CI) P Mean (CI) P Mean (CI) P
Total standard scores 8.05 (3.3) 9.14 (3.3) −1.1 (−2.3 to 0.71) .065 8.05 (3.3) 9.65 (3.2) −1.61 (−2.7 to −0.5) .004 9.14 (3.3) 9.65 (3.2) −0.51 (−1.6 to 0.5) .340
Manual dexterity 8.06 (3.584) 8.81 (2.922) −0.748 (−1.904 to 0.408) .202 8.06 (3.584) 9.57 (3.479) −1.507 (−2.673 to −0.341) .012 8.81 (2.922) 9.57 (3.479) −0.759 (−1.825 to 0.307) .161
Aiming and catching 8.73 (3.512) 9.60 (3.305) −0.877 (−2.085 to 0.330) .153 8.73 (3.512) 9.39 (2.768) −0.667 (−1.695 to 0.361) .202 9.60 (3.305) 9.39 (2.768) 0.210 (−0.781 to 1.202) .676
Balance 8.21 (3.245) 9.52 (3.464) −1.306 (−2.490 to −0.122) .031 8.21 (3.245) 10.23 (3.125) −2.017 (−3.068 to −0.965) <.001 9.52 (3.464) 10.23 (3.125) −0.711 (−1.785 to 0.380) .193
Abbreviation: CI, confidence interval.

Less Than 15th Centile on MABC

Thirty percent of boys and 26% of girls who had undergone CS scored less than 15th centile indicating at risk for motor impairment. Twenty-five percent of boys and 8% of girls who had undergone NCS and 13% of boys in the control group and 9% of girls in the control group scored less than 15th centile MABC-2.

Less Than Fifth Centile on MABC

For the children who had undergone CS, 10% of boys and 21% of the girls scored less than fifth centile on MABC-2, which indicates significant motor difficulties. Thirteen percent of boys and 8% of girls who had undergone NCS, and 13% of girls and 8% and 9% of control boys and girls, respectively, scored less than fifth centile on the MABC-2.

Risk for Motor Impairment

Children who had undergone CS were 3.0 times (95% confidence interval [CI]: 1.3-7.1) more likely than children in the control group and 1.7 times more likely than children who had undergone NCS (95% CI: 0.8-4.1) to score less than 15th centile on MABC-2 and have increased risk of DCD. Children who had NCS were 1.7 times (95% CI: 0.7-4.2) more likely than controls to score less than 15th centile and have increased risk of DCD.

Children who had undergone CS were 1.9 times (95% CI: 0.7-5.3) more likely than controls and 1.4 times more likely than children who had undergone NCS (95% CI: 0.5-4.0) to score less than fifth centile on MABC-2 indicating significant movement difficulties. Children who had undergone NCS were 1.4 times (95% CI: 0.5-4.1) more likely than children in the control group to score less than fifth centile.

Behavioral and Emotional Difficulties in Children With Increased Risk of DCD

Results of parent- and teacher-reported CBCL results are shown in Table 3. Only statistically significant results from BRIEF are reported later.

TABLE 3 - Independent T Tests Comparing the Means of Children Who Scored Less Than 15th Centile With Children Who Scored 15th Centile and Greater, and Less Than Fifth Centile compared With Fifth Centile and Greater on the Movement Assessment Battery for Children (Second Edition) (MABC-2) (Combined for Cardiac Surgery, Non–Cardiac Surgery, and Control Group) and Parent and Teacher Responses on the CBCL
CBCL Item Less Than 15th Centile Compared with ≥15th Centile Less Than 5th Centile Compared With ≥5th Centile
Mean Difference Significance, P Mean Difference Significance, P
Parent reported
Thought problems 7.1 (4.2-10.0) <.001 8.4 (3.5-13.4) .002
Anxious/depressed 3.7 (0.8-6.6) .013 4.9 (1.2-8.5) .012
Withdrawn/depressed 6.3 (3.2-9.5) <.001 7.0 (2.2-11.9) .007
Somatic complaints 2.5 (−0.1 to 5.2) .062 2.2 (−0.9 to 5.4) .157
Social problems 7.2 (4.4-9.9) <.001 8.1 (4.3-11.9) <.001
Attention problems 8.0 (4.2-11.8) <.001 8.7 (4.4-13.1) <.001
Rule-breaking behaviors 3.2 (1.0-5.3) .004 4.9 (1.8-7.9) .003
Aggressive behaviors 3.9 (−0.2 to 8.1) .061 7.33 (3.3-11.3) .001
Other problems 1.7 (0.4-2.9) .010 2.4 (0.7-4.2) .009
Total score 20.7 (12.3-29.1) <.001 24.8 (14.5-35.0) <.001
Total T score 9.8 (6.2-13.4) <.001 11.7 (7.4-16.1) <.001
Teacher reported
Thought problems 5.5 (2.1-8.9) .002 8.4 (3.5-13.4) .002
Anxious/depressed 1.7 (−1.0 to 4.4) .201 4.0 (−0.3 to 8.2) .065
Withdrawn/depressed 3.9 (0.1-7.6) .042 7.9 (1.4-14.3) .020
Somatic complaints 1.8 (−0.6 to 4.3) .141 4.1 (−0.1 to 8.3) .056
Social problems 7.6 (3.9-11.4) <.001 11.5 (6.3-16.7) <.001
Attention problems 5.0 (1.6-8.3) .004 7.7 (3.5-11.9) .001
Rule-breaking behaviors 3.4 (0.4-6.7) .048 5.4 (0.6-10.3) .029
Aggressive behaviors 0.8 (−4.9 to 6.5) .782 4.6 (0.3-9.0) .037
Other problems 0.4 (−0.1 to 0.9) .134 0.7 (−0.3 to 1.6) .146
Total score 18.7 (6.9-30.6) .003 29.5 (14.2-44.8) .001
Total T score 8.7 (3.9-13.4) .001 13.3 (7.5-19.1) <.001
Abbreviation: CBCL, Child Behavior Checklist.

CS Group

Parent Report. On the BRIEF, children who had undergone CS who scored less than 15th centile on MABC-2 had statistically significantly worse parent-reported emotional control problems and difficulties with initiation with mean differences of 8.48 (95% CI: 1.4-15.6, P = .021) and 11.76 (95% CI: 5.13-18.4, P = .001), respectively, compared with children who had undergone CS who scored greater than 15th centile on MABC-2. Children who had undergone CS and increased risk of DCD had more parent-reported difficulties with working memory and planning with mean differences of 11.55 (95% CI: 4.9-18.2, P = .001) and 13.49 (95% CI: 7.5-19.5, P value of less than .001), respectively, compared with children who had undergone CS who scored greater than 15th centile on the MABC-2. Children who scored less than 15th centile also had significantly higher parent-reported difficulties with organization and monitoring with mean differences of 5.83 (95% CI: 0.25-11.4, P = .041) and 9.34 (95% CI: 3.5-15.1, P = .002), respectively.

Teacher Report. Children who scored less than 15th centile who had undergone CS had statistically significantly worse organization on the BRIEF compared with children who scored greater than 15th centile with a mean difference of 8.84 (95% CI: 0.3-17.4, P = .044).

Non–Cardiac Surgical Group

Parent Report. On the BRIEF, children who had undergone NCS who scored less than 15th centile on MABC-2 had statistically significantly worse parent-reported difficulties, with inhibition and shifting with a mean difference of 7.91 (95% CI: 2.5-13.3, P = .005) and 11.96 (95% CI: 6.0-18.0, P value of less than .001), respectively, when compared with children who had undergone NCS who scored greater than 15th centile on MABC-2. They also had higher parent-reported difficulties with behavior and initiation with a mean difference of 7.78 (95% CI: 2.1-13.4, P = .008) and 7.01 (95% CI: 1.1-13.0, P = .021), respectively.

Teacher Report. On teacher-reported BRIEF, children who scored less than 15th centile who had undergone NCS had statistically significantly worse teacher-reported inhibit and working memory compared with children who scored greater than 15th centile with a mean difference of 10.98 (95% CI: 1.2-20.7, P = .031) and 7.64 (95% CI: 0.7-14.6, P = .032) respectively. They also had significantly more difficulties with planning and monitoring with a mean difference of 9.44 (95% CI: 1.80-17.1, P = .017) and 11.48 (95% CI: 4.7-18.2, P = .001), respectively.

Control Group

Parent Report. On the BRIEF, children in the control group who scored less than 15th centile on MABC-2 had statistically significantly worse parent-reported difficulties with shift and emotional control compared with control children who scored greater than 15th centile on MABC-2 with a mean difference of 12.31 (95% CI: 5.9-18.8, P value of less than .001) and 8.82 (95% CI: 1.0-16.6, P = .027) respectively. They also had higher parent-reported difficulties with working memory and monitor with a mean difference of 8.80 (95% CI: 2.4-15.2, P = .008) and 8.84 (95% CI: 2.2-15.5, P = .010), respectively. Children in the control group with increased risk of DCD had higher parent-reported difficulties with behavior with a mean difference of 10.86 (95% CI: 4.0-17.8, P = .002).

Teacher Report. On the teacher-reported BRIEF, control children who scored less than 15th centile had statistically significantly worse teacher-reported initiation compared with children who scored greater than 15th centile with a mean difference of 8.54 (95% CI: 0.0-17.0, P = .049).

DISCUSSION

The developmental outcomes for the surgical population to date have not explored the risk of DCD, despite the research identifying the increased rates of DCD in other high-risk populations such as children who are born preterm or low birth weight.10–12 The lack of research about the risk for DCD is probably an artifact of some neonatal follow-up ending for the surgical population before a DCD diagnosis is recommended (at least 5 years of age).8 This is the first research that has identified the increased rates of increased risk of DCD for children who have had early major CS or NCS.

Children who had undergone CS had 3 times the risk for DCD or motor impairment and children who had undergone NCS had at least 1½ times the risk compared with children in the control group. Our findings of the increased rate of increased risk of DCD among the surgical population, in particular, children who had undergone CS are important for clinical practice.

Our results are consistent with the risk previously identified in other populations including children born preterm, low birth weight, or male sex. First, in the preterm population, a systematic review on studies of children born less than 37 weeks of gestation identified increased motor impairments (40.5% pooled estimate for mild to moderate impairment classified as less than16th centile on MABC-2 and 19% for moderate impairment of fifth centile and less on MABC-2).12 Second, for children who were born low birth weight, extremely low birth weight, or extremely preterm, with reported prevalence of DCD at 8 years of 16%12 and 26%10 (children born less than 1000 g or between 22 and 27 weeks of gestation). Third, male sex is another risk factor for DCD.10

Developmental coordination disorder is known to be more common in infants born preterm. In these infants, not only has the brain not finished developing at birth but the neonatal intensive care unit is also a harsh developmental environment (with lights, noise, and procedural pain) compared with the womb. Efforts have been made through the Newborn Individualized Developmental Care and Assessment Program and other approaches to prevent and lessen the damaging effects of the neonatal intensive care unit both for infants born preterm and those with inpatient surgical stays as per this present study. What is not yet clear is whether these interventions are potent enough to overcome and protect against brain injury from hospitalizations20 or whether hospitalization may also have a role in the development of DCD.

Follow-up services should be standardized in terms of frequency and length of follow-up for the surgical populations. Increased risk of DCD in the surgical population should be considered during follow-up appointments, which need to extend beyond 5 years of age in line with clinical practice guidelines for the assessment of DCD.8 Earlier diagnosis will enable earlier intervention and may improve function and reduce the longer-term effect and burden for the child and their family.

A systematic review and meta-analysis found that activity-focused interventions had a positive effect for children with DCD and found a moderate to large effect size for a range of interventions for children aged 4 to 12 years.21 The 2019 International Clinical Practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD guidelines state that there is strong, high-level evidence, which recommends that an activity-oriented and participation-oriented approach be used for children with DCD.8 The recently published Clinical Practice Guidelines for the physical therapy management of children with DCD highlights evidence-based approaches to improving a range of outcomes for children with DCD. Importantly, the guidelines indicate that children with coordination difficulties, those who score between 5th and 15th centile (or at risk of a movement difficulty), and those who score fifth centile and less on the MABC-2 benefit from these evidence-based interventions.22

Children with DCD have atypical brain development with different regions of brain activation during tasks compared with children with no DCD.23 Changes in brain development occur for infants with congenital heart disease, which are likely to begin in utero.24 Brain magnetic resonance imaging changes have been identified prior to corrective CS, which are likely to have an effect on longer-term neurological development.25 In addition, children with congenital cardiac disease have lower levels of oxygen saturations and repeated hypoxic events. It is unclear how these brain changes relate to the development of DCD for this population.

As technology advances, the genetic pathways associated with congenital heart disease are becoming increasingly understood.26 Researchers are investigating the potential causal pathways for DCD including the genetic/hereditary components and the links between DCD and other neurodevelopmental disorders.27 Further research investigating these aspects and their link to DCD would provide further information about potential causes for this vulnerable group and potential guidance for clinicians on strategies to mitigate the risks for these infants.

Our results are consistent with previous research, which identified that children with DCD have poorer emotional and psychological well-being.1,28 Parents and teachers in our study reported increased levels of problems with thought for all groups who had increased risk of DCD. For both surgical groups, there were statistically significantly increased difficulties with withdrawn or depressed behavior, social problems, working memory, and planning difficulties for children who had increased risk of DCD compared with those who did not.

The high risk of DCD in children who are born low birth weight or preterm is well established. Our research indicates that clinicians should also consider the surgical population as a high-risk group for DCD and the associated mental health and executive functioning difficulties that are frequently associated with the neurodevelopmental disorder. Increased awareness and detection of DCD are imperative to improve function and reduce the long-term burden as described previously for the child and its family.

One limitation of our study is that a formal functional measure such as the Developmental Coordination Disorder Questionnaire 2007(DCDQ'07)29 was not administered at the time of the motor, cognitive, and parent/teacher assessments. This would have provided more details about the specific functional effect for the child and would have contributed criteria B in the diagnosis of DCD.

CONCLUSION

The increased risk of DCD and co-occurring behavioral and emotional difficulties are prevalent in the cardiac surgical and non–cardiac surgical populations for children aged 8 to 9 years. The surgical population should be considered a high-risk and vulnerable population for DCD. In line with clinical practice guidelines, follow-up services for children who have undergone neonatal surgery should continue beyond 5 years of age and include an assessment for DCD. This would allow for the early referral to targeted therapy to minimize the longer-term effect of DCD on the child's emotional, social, and academic well-being.

What this adds to the evidence:

  • The surgical population should be considered a high-risk and vulnerable population for DCD.
  • Children who had undergone cardiac surgery had 3 times the risk for DCD at 8/9 years compared with controls.
  • Children who had undergone non–cardiac surgery had greater than 1.5 times the risk of DCD at 8/9 years compared with controls.
  • Children who had undergone neonatal surgery have poorer motor skills than controls.
  • In line with clinical practice guidelines, follow-up services for children who had undergone neonatal surgery should continue beyond 5 years of age and include an assessment of DCD.

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Keywords:

development; Developmental Coordination Disorder (DCD); motor development; newborn surgery

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