Name of Program: Clinique d’investigation neurocardiaque (CINC) / Neurocardiac Investigation Clinic
Year Program Established: 2013
Program Leader: Dr. Nancy Poirier, Cardiac Surgeon
Key Staff and Specialties:
Our neurocardiac developmental program is interdisciplinary and includes:
- Pediatric neurologists
- Developmental pediatricians
- Occupational therapists
- Speech and language pathologist
- Psychoeducator (for ASD diagnostics)
- Clinical nurse specialist (as coordinator)
- Administrative support
- Associated to the cardiology team (cardiologist, cardiac surgeon, social worker, nurses, etc.), neonatalogy team & PICU team
- Associated to the research center with researchers in different fields, including Neurology, Neonatalogy, Neuropsychology, Occupational therapy, Engineering
Age Range of Patients Served: Birth – 8 years (our older patients will turn 8 in early 2021)
Description of Inpatient Program(s):
At the CHU Sainte-Justine, all newborns with moderate-to-severe congenital heart disease (approximately 60 newborns per year) requiring surgery within the 1st year of life are followed at the CINC. Our inpatient systematic program includes:
- Newborn neurological evaluation
- Pre & post-surgery EEGs
- Pre & post-surgery brain MRI
- Pre & post-surgery NIRS
- Pre & post-surgery physiotherapist
- Occupational therapy, if needed
- Consultation with a nutritionist, if needed
Description of Outpatient Program(s):
At the CINC, our inpatient follow-up program starts at birth and our outpatient at the age 2 months and includes systematic and standardized neurodevelopmental screening and assessments at multiple pre-established time points. An overview of the program is shown in Figure 1. This allows us to follow developmental trajectories and determine whether the child requires additional direct intervention with a professional. The neurodevelopmental screening and assessments include standardized neurological examinations, motor, cognitive, and language assessments with a professional as well as affective and functional evaluations by parental questionnaires. Most assessment tools are part of the CNOC recommended protocol. Referrals to rehabilitation centers are done if needed. The systematic follow-up program offered at the CINC also includes interventions provided to every child. These interventions include educational support to the family, such as a) information about infant development, b) discussions/explanations of infant behavior, and c) active involvement of the parent in interactions with the infant with feedback from a professional. In addition to the systematic intervention, an early and individualized intervention protocol is established if needed based on the child’s specific needs identified by the results of each assessment. Individualized intervention protocols may include specific intervention sessions with a therapist and therapeutic developmental support for the child, such as recommendations of educational activities with the child or daily home exercises. When appropriate, a written individualized intervention plan is given to parents.
Description of research or QI projects in cardiac neurodevelopment – undergoing or accomplished:
Many research projects have been completed or are ongoing at the CINC. Here are some selected publications:
- Fourdain S, Caron-Desrochers L, Simard MN, Provost S, Doussau A, Gagnon K, Dagenais L, Presutto E, Prud’homme J, Boudreault-Trudeau A, Constantin IM, Desnous B, Poirier N, Gallagher A, on behalf of the CINC team. (2020) The Impacts of a Developmental Follow-up Program on Neurodevelopment in Congenital Heart Disease: the CINC Study. Frontiers in Pediatrics, section Pediatric Cardiology
- Lépine J, Gagnon K, Prud’homme J, Vinay MC, Doussaud A, Fourdain S, Provost S, Belval V, Bernard C, Gallagher A, Poirier N, Simard MN, on behalf of the CINC team. (submitted) Utility of the ASQ-3 in screening for developmental delay in children with Congenital Heart Disease. Journal of Pediatrics.
- Fourdain S, Simard MN, Dagenais L, Materassi M, Doussau A, Goulet J, Gagnon K, Prud’Homme J, Vinay MC, Dehaes M, Birca A, Poirier NC, Carmant L, Gallagher A, on behalf of the CINC interdisciplinary team (2020) Gross Motor Development of Children with Congenital Heart Disease Receiving Early Systematic Surveillance and Individualized Intervention: Brief Report, Developmental Neurorehabilitation, doi: 10.1080/17518423.2020.1711541
- Chowdhury RA, Marandyuk B, La KA, Desnous B, Mahdi Z, Benhmida I, Aube G, Gallagher A, Du Pont-Thibodeau G, Birca A, Raboisson MJ, Dehaes M. *Pre- and postoperative alterations of cerebral hemodynamics and oxygen metabolism in neonates with dextro-transposition of the great arteries and their association with 4-months motor outcome. 2020 Canadian National Perinatal Research Meeting (CNPRM). Banff, AB, Canada (*Oral presentation).
- Fourdain S, St-Denis A, Harvey J, Carmant L, †Gallagher A, †Trudeau N. Language development in children with congenital heart disease aged 12 to 24 months. European Journal of Pediatric Neurology 2019; 23(3): 491-499. doi: https://doi.org/10.1016/j.ejpn.2019.03.002 † Co-senior authors
- Desnous B, Lenoir M, Marandyuk B, Doussau A, Beaulieu-Genest L, Poirier N, Carmant L, Birca A. for the CINC multidisciplinary team (equal contribution as co-senior authors); Epilepsy and seizures in children with Congenital Heart Disease: a prospective study. Seizure. 2018 Nov 26;64:50-53. doi: 10.1016/j.seizure.2018.11.011.
- Dagenais L, Materassi M, Desnous B, Vinay M-C, Doussau A, Sabeh P, Prud’homme J, Gagnon K, Lenoir M, Charron M-A, Nuyt AM, Beaulieu-Genest L, Poirier N, Carmant L, Birca A. for the CINC multidisciplinary team (equal contribution as co-senior authors); Superior performance in prone in infants with congenital heart disease predicts an earlier onset of walking, Journal of Child Neurology, 2018. doi: 10.1177/0883073818798194
- Gallagher A, Dagenais L, Doussau A, Décarie JC, Materassi M, Gagnon K, Prud’homme J, Vobecky S, Poirier N, Carmant L (2017). Significant motor recovery in an infant with congenital heart disease and a rolandic stroke: the impact of early intervention. Developmental Neurorehabilitation 20: 165-168. doi: 10.3109/17518423.2015.1132280
Unique features and strengths of this program:
- Our program is based on strong interdisciplinary work: combined neurology-cardiology-neonatologist-intensivist work;
- Clinical nurse specialist oversees families’ needs and interdisciplinary clinics where all professionals see patients in one day;
- Strong collaboration between clinical and research teams.