Purpose: To describe current practice of pediatric sternal precautions (PSPs) and prone positioning restrictions (PPRs) in infants after median sternotomy. Methods: A Web-based survey with 21 questions was developed on the basis of a review of current literature and expert consultation. Snowball sampling resulted in 68 participants well represented by profession throughout the United States. Results: Approximately 80% of participants reported having institutional protocols for PSPs. Most common reported PSPs were no lifting at the axillae and no pulling of arms to achieve sitting. PSPs also included PPRs. The opinions of participants supported no PPRs or modified PPRs compared with strict PPRs. Conclusions: Types of PPRs varied across participants, with the majority of participants in favor of modified PPRs while PSPs were less varied. Research is needed to examine the effects of PSPs and PPRs in infants post–median sternotomy.

Children and adolescents (C&As) with congenital heart defects (CHDs) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased cerebral perfusion. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify evidence describing the impact of physical activity (PA) interventions on EF in C&As with CHDs. The following databases were searched from 2000 to 2024: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. The inclusion criteria consisted of participants aged from birth to 18 years with CHD, interventions related to PA, and EF as an outcome measure. Articles were excluded if adults were included, translation to English was impossible, and full access was unavailable. Of 613 initial articles, 3 were analyzed, with only 1 meeting all inclusion criteria. The included study found significant improvements in self-reported cognitive functioning and parent-reported social functioning after 12 weeks of aerobic exercise in children aged 10–15 years with CHDs. Common themes among the reviewed articles indicated that EF remains impaired throughout the lifespan, children have unique interventional and developmental needs, and research remains limited despite theoretical benefits. Further investigation of the effect of PA on EF in C&As with CHDs is needed.

Children and adolescents (C&A) with congenital heart defects (CHD) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased oxygen saturation. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify current evidence describing the impact of physical activity (PA) interventions on EF in C&A with CHD. The following databases were searched from 2014-present: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. Article inclusion criteria consisted of participants from birth to 18 years with CHD, interventions related to PA, and EF as an outcome. Articles were excluded if: adults were included, translation to English was impossible, and full access was unavailable. As a result of the review, 431 studies were screened. Three articles underwent full analyzation and only one met all criteria and this study found that with exercise there were significant improvements on self-reported cognitive functioning and parent-reported social functioning. Despite theoretical benefits, only one published study has investigated the role that PA interventions have on EF in C&A with CHD. Further investigation of the effect PA interventions have on EF in C&A with CHD is needed.

Background: Prone positioning is an essential component of early rehabilitation and motor development in infants following cardiac surgery involving median sternotomy; however, restrictions remain variable due to concerns regarding sternal healing and safety. Due to a lack of guiding evidence, many institutions implement a time-based restriction to prone positioning. Methods: A retrospective cohort study was conducted of infants with single-ventricle physiology undergoing cardiac surgery via median sternotomy at a single paediatric centre between 2022 and 2025. Data collected included time to physical therapy evaluation, time to initiation of prone positioning, clinical factors influencing positioning, and sternal healing outcomes after discharge. Descriptive statistics were used to summarise timing and outcomes. Results: A total of 37 patients were included with 46 surgical encounters. The median age at first surgery was 65 days (interquartile range: 6–204). Physical therapy evaluation occurred at a median of 9 days post-operatively (interquartile range: 7–15; range: 3–29), and prone positioning was initiated at a median of 15 days (interquartile range: 10–22; range: 4–115). Timing differed by surgical stage, with earlier initiation following Glenn compared to Norwood procedures. Delays in prone positioning were associated with medical instability, delayed sternal closure, and the presence of invasive lines and devices. No cases of sternal dehiscence, infection, or adverse healing outcomes were identified at outpatient follow-ups. Conclusions: Prone positioning following infant cardiac surgery demonstrates variability in timing but appears safe when guided by clinical stability and patient-specific factors. These findings support a shift from time-based restrictions to individualised, criteria-driven approaches.

Advances in surgical and medical management have improved survival for individuals with Fontan physiology (FP), increasing attention to long-term neurocognitive impairments. We propose the Cardiopulmonary–Brain Axis Hypothesis, identifying respiratory muscle performance (RMP) as a potentially modifiable contributor to executive function in FP. Drawing on evidence from cardiovascular and respiratory physiology, autonomic neuroscience, cerebrovascular biology, and neurocognitive research, this framework explores potential relationships among RMP, FP, respiratory muscle metaboreflex activation, autonomic regulation, cerebral perfusion, and executive function. Fontan-specific studies demonstrate the influence of respiration on venous return and pulmonary blood flow, while selected inspiratory muscle training (IMT) studies report improvements in respiratory function. Building on these findings, we hypothesize that improvements in RMP following IMT may enhance respiratory pump efficiency, favorably influence Fontan hemodynamics, attenuate respiratory muscle metaboreflex activation, and support autonomic regulation and cerebral perfusion, with potential downstream improvements in executive function. However, evidence supporting these relationships varies, with several mechanisms derived primarily from non-Fontan populations. The pathway remains untested, and improvements in executive function following IMT have not been established in FP. The Cardiopulmonary–Brain Axis Hypothesis provides a biologically plausible, testable framework to guide future longitudinal and interventional investigations examining the potential relationships between RMP, cardiopulmonary function, and brain health.