Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

Abstract

Objectives The objectives of this review are to discuss the scope of neurologic injuries in newborns with congenital heart disease, the mechanisms of injury, including pre-natal, pre- intra- and postoperative factors, neurodevelopmental outcomes and therapeutic strategies for the timely intervention and prevention of neurologic injury. Data Source MEDLINE, PubMed Conclusion At the current time, important research is underway to (1) better understand the developing brain in the fetus with complex congenital heart disease, (2) to identify modifiable risk factors in the operating room and intensive care unit in order to maximize long-term neurodevelopmental outcomes and (3) develop strategies to improve family psychosocial health, childhood development and health-related quality of life following hospital discharge. Crucial in this effort is the identification of an early post-operative surrogate variable with good predictive validity for long-term outcomes. If an appropriate surrogate variable for long term outcomes can be identified, and measured relatively early after surgical intervention for complex congenital heart disease, reliable clinical trials can be undertaken to improve upon current outcomes.

Neurodevelopmental Abnormalities and Congenital Heart Disease

“…Increased hospital stay is necessary to stabilize hemodynamics and often involves lengthy exposure to sedatives which may also further impact neurodevelopment 130 . A recent study assessed operative and postoperative factors associated with poor neurodevelopmental outcomes at 13 months of age following cardiac surgery in infancy 131 .…”

“…Protracted hospital stay also exacerbates maternal and family stress and can result in an unhealthy parental-child relationship following hospital discharge as the family experiences challenges accommodating their child’s medical needs and neurodevelopmental deficits; in addition, maternal angst has a negative impact on child behavior which in turn increases maternal stress (for review, see 130 ).…”

Neurologic outcomes after heart surgery

“…Each hour spent at an SVO2 < 40% increased the risk of abnormal neurodevelopmental outcome nearly 5‐fold. These data indirectly support the goal‐directed approach used in most pediatric CICUs …”

Development of a Congenital Heart Surgery Composite Quality Metric: Part 1—Conceptual Framework

“…Both complications and LOS were included in a previously developed STS-CHSD statistical model that defined the morbidity risk associated with different surgical procedures [18]. Finally, prior studies have shown that prolonged LOS has a deleterious impact on longer term neurodevelopmental outcomes, likely reflective of LOS serving as a marker of overall postoperative morbidity [29]. The group also considered metrics associated with LOS such as duration of mechanical ventilation; however, not all STS-CHSD centers submit complete data for this variable.…”