A cohort study implementing a developmental care program for hospitalized children with congenital heart disease was associated with a 54% reduction in delirium and improved cognitive outcomes.
Published in JAMA Network Open, the study examined the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program at a U.S. tertiary care children's hospital. Researchers analyzed quality improvement data from 1331 admissions for 1019 pediatric patients (median age 3.65 months; 57.9% male) between September 2018 and September 2023.
The program's five key interventions included medical and nursing order panels, developmental kits, bedside developmental plans, caregiver mental health support, and developmental care rounds. Each intervention was linked to a decrease in delirium, as measured by the Cornell Assessment of Pediatric Delirium, where scores above nine indicated delirium.
The mean number of days with delirium per patient dropped from 3.05 to 1.38 between the first and second phases of CINCO implementation. Cognitive scores, measured by the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-4), improved from 81.67 to 93.92 between phases. Bedside developmental plans contributed notably to this improvement (B = 8.585; 95% CI, 2.247-14.923; P = .008).
"Among hospitalized children with congenital heart disease (CHD), the implementation of an inpatient developmental care program was associated with reduced incidence of delirium and higher cognitive scores," said Kelly R. Wolfe, PhD, ABPP-CN, of the Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.
While delirium was associated with lower BSID-4 cognitive scores, researchers found no significant relationship between delirium and motor or language scores.
A key study limitation was that only about 12% of the hospitalized cohort returned for outpatient neurodevelopmental follow-up. Despite this limitation, the findings suggest pediatric cardiac centers may benefit from adopting these low-cost, low-risk, and generalizable interventions to enhance neurodevelopmental outcomes.
The authors reported no conflicts of interest.
