Improving neurodevelopment in infants with complex congenital heart disease

Abstract

Worldwide, more than 400,000 infants are born each year with complex congenital heart disease (CCHD) requiring surgical intervention within the first months of life. Although improvements in perioperative care have resulted in increased rates of survival, more than half of infants with CCHD have neurodevelopmental impairments affecting subsequent educational achievements, job opportunities, and mental health. Brain maturity and impaired outcomes in infants with CCHD are similar to those of prematurely born infants. Developmentally supportive care, including foundational application of kangaroo care (KC), improves neurodevelopment in premature infants. Provision of developmentally supportive care with KC during the early hospitalization of infants with CCHD has the potential to similarly improve neurodevelopment. The purposes of the article are to describe common congenital heart defects, describe developmentally supportive care with an emphasis on KC, and to offer specific recommendations for KC and research in infants with CCHD.

Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease

“…The significant reductions in stress response and improvements in attachment for participants in our study provide support for the use of SSC as a nurse-driven intervention in PCICUs. Nurses can collaborate with interdisciplinary health care providers in PCICUs to establish specific holding guidelines to standardize when and how infants can be held for SSC, as one PCICU nursing team has documented (Torowicz et al, 2012) and others have advocated (Harrison, 2019;Peterson, 2018;Sood et al, 2016). A recent international benchmarking study found that 50% of PCICUs allowed infants to be held out of bed with transthoracic intracardiac catheters, an intravenous catheter used specifically after cardiac surgery (Lisanti, Fitzgerald, et al, 2019).…”

“…Skin-to-skin care (SSC) is a specific form of holding in which the mother holds the unclothed, diapered infant directly to her bare chest. Although researchers during the past decade have called for an increase in developmentally supportive care in PCICUs, including interventions such as SSC (Butler et al, 2017;Harrison, 2019;Lisanti et al, 2016;Lisanti, Vittner, et al, 2019;Peterson, 2018;Peterson & Evangelista, 2017;Torowicz et al, 2012), considerable variation in practice exists across PCICUs (Miller et al, 2020;Sood et al, 2016). SSC and holding in general have not been integrated into the standard of care across PCI-CUs.…”

Manejo neurocognitivo en cardiopatía congénita: revisión sistemática de recomendaciones de práctica clínica

“…El conocimiento del curso de vida del paciente con CC respecto a alteraciones neurocognitivas ha permitido detectar oportunidades de identificación, prevención e intervención. Estas alternativas han sido analizadas en diferentes revisiones [9][10][11] , llevadas a guías de práctica clínica (GPC) y declaraciones científicas (DC), entre las que se destaca la guía de la Asociación Americana del Corazón/Academia Americana de Pediatría 12 ; incluso algunos hospitales, principalmente en Estados Unidos, han implementado "cardiac neurodevelopmental clinics" conformadas por equipos interdisciplinarios de seguimiento del paciente con CC buscando optimizar desde la infancia sus resultados de neurodesarrollo y funcionalidad 13,14 . No obstante, no se ha realizado un proceso sistemático que identifique las recomendaciones de práctica y valore su calidad e implementabilidad en diferentes contextos y escenarios de práctica, y la calidad de la evidencia en la cual se basan las recomendaciones.…”

Family-Centered Care at Pediatric Cardiac Intensive Care Units in Germany and the Relationship With Parent and Infant Well-Being: A Study Protocol

“…The results of this study supports the notion that the beneficial effects of FCC may extend to various medical cohorts. In pediatric cardiology, several authors argue that FCC practices may be applicable to infants with CHD, pointing to a mismatch between the neurobiological needs of these infants and the hospital environment (23)(24)(25)(26)(27)(28)(29). The neurological vulnerability observed in infants with CHD resembles that of premature infants, most notably with regard to white matter immaturity (30).…”