48 A New Method for Scoring Behavior in Newborn Infants with Congenital Heart Disease

Abstract

Introduction: Previous acidosis and hypoxia is common in newborn infants with newly diagnosed congenital heart disease (CHD). These infants often need prostaglandin E₁ (PGE₁) and they may show fatigue and irritability. Very little is known about the behavior of newborn infants with CHD. The aim of the present study was to create a simple method for pre- and postoperative evaluation of behavior in newborn infants with CHD, “Behavior score for Infants with Congenital Heart disease”, BICH.

Method: NICU nurses with experience from care of infants with CHD were asked to describe behavior of infants with CHD. Based on these descriptions, a scale with 41 items divided into 3 categories (general, sleep, wakefulness) was created and applied preoperatively on 34 infants with CHD. The infants' gestational ages were 36–41 weeks and their postnatal ages 1 to 15 (median 3) days. Brazelton Neonatal Behavior Assessment Scale (NBAS) was performed in 15 of the 34 infants. Postoperatively 22 infants were assessed (11 with NBAS).

Results: The overall mean preoperative BICH score correlated (p-value; r_s) with: lowest preoperative pH (0.023; 0.390) and base excess (0.001; 0.562), administered dose of PGE₁ (0.001; -0.548). Furthermore the mean BICH score also correlated significantly with several supplementary items from the NBAS, including quality of alertness (0.022; 0.586), cost of attention (0.008; 0.678), examiner facilitation (0.003; 0.724), general irritability (0.022; 0.605) and robustness (0.015; 0.633). The postoperative BICH score correlated significantly with duration of peroperative perfusion time (0.014; 0.517) and aortic clamping (0.027; 0.472), and with two supplementary NBAS items: general irritability (0.008; 0.812), and state regulation (0.004: 0.851). The preoperative mean overall and subgroup BICH scores were significantly lower than the postoperative scores (p= 0.001, 0.000, 0.002 and 0.002, respectively).

Conclusion: A new method for evaluation of newborn infants with congenital heart disease, BICH, has been developed and shown good correlation with preoperative and postoperative morbidity as well as with several supplementary NBAS items.

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