Optimizing Neurodevelopmental Outcomes in Neonates With Congenital Heart Disease

Ortinau, Cynthia M.; Smyser, Christopher D.; Arthur, Lindsay; Gordon, Erin E; Heydarian, Haleh; Wolovits, Joshua S.; Nedrelow, Jonathan; Marino, Bradley S.; Levy, Victor Y

doi:10.1542/peds.2022-056415l

Cited by 17 publications

(10 citation statements)

References 196 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neonates and infants with critical congenital heart disease are at risk for a number of postnatal complications, including growth failure, feeding and breastfeeding challenges, and necrotizing enterocolitis [24][25][26][27][28]. They are also known to be at risk for neurodevelopmental impairments [29,30]. Ongoing SSC in an intensive care setting can be challenging, and many parents have expressed fears around holding their infant in the ICU as well as significant stress throughout the ICU stay [31,32].…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates

et al. 2023

View full text Add to dashboard Cite

Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II–III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%. Supplementary Information The online version contains supplementary material available at 10.1007/s00246-023-03149-2.

show abstract

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates

et al. 2023

View full text Add to dashboard Cite

show abstract

“…While research into improving current diagnostic, prognostic and treatment options for NDD in CHD is on-going, there are a number of practical ways in which neurodevelopmental outcomes can be maximised for the CHD patient ( 69 ).…”

Section: Discussionmentioning

confidence: 99%

“…Predominant lesions include patterns of white matter injury and stroke; the prevalence and severity of which are typically worse in infants with univentricular lesions ( 65 , 68 ). Recently, Peyvandi and colleagues found that moderate to severe peri-operative injury is associated with subsequent reduced brain growth ( 68 ), demonstrating a complex interplay between brain development and acquired injury and a possible “two-hit phenomena” ( 69 ).…”

Section: Brain Structure and Function: Insights From Neuroimagingmentioning

confidence: 99%

Biological and structural phenotypes associated with neurodevelopmental outcomes in congenital heart disease

Verrall¹,

Patel²,

Travitz³

et al. 2023

Transl Pediatr

View full text Add to dashboard Cite

Neurodevelopmental disability (NDD) is recognised as one of the most common comorbidities in children with congenital heart disease (CHD) and is associated with altered brain structure and growth throughout the life course. Causes and contributors underpinning the CHD and NDD paradigm are not fully understood, and likely include innate patient factors, such as genetic and epigenetic factors, prenatal haemodynamic consequences as a result of the heart defect, and factors affecting the fetal-placental-maternal environment, such as placental pathology, maternal diet, psychological stress and autoimmune disease. Additional postnatal factors, including the type and complexity of disease and other clinical factors such as prematurity, peri-operative factors and socioeconomic factors are also expected to play a role in determining the final presentation of the NDD. Despite significant advances in knowledge and strategies to optimise outcomes, the extent to which adverse neurodevelopment can be modified remains unknown. Understanding biological and structural phenotypes associated with NDD in CHD are vital for understanding disease mechanisms, which in turn will advance the development of effective intervention strategies for those at risk. This review article summarises our current knowledge surrounding biological, structural, and genetic contributors to NDD in CHD and describes avenues for future research; highlighting the need for translational studies that bridge the gap between basic science and clinical practice.

show abstract

“…These strategies can include promoting parent-child bonding with kangaroo care or music therapy, reducing noise and implementing cycled lighting to maintain the circadian rhythm. 40…”

Section: Discussionmentioning

confidence: 99%

The cumulative impact of clinical risk on brain networks and associations with executive function impairments in adolescents with congenital heart disease

Ehrler,

Speckert,

Kretschmar

et al. 2023

Preprint

View full text Add to dashboard Cite

Congenital heart disease (CHD) is known to negatively affect brain development. Individual clinical factors have been identified to contribute to this detrimental effect, however, the cumulative effect of these factors on brain development and neurodevelopmental outcomes are not fully understood. Our study utilized structural brain connectomics as an indicator of brain development to investigate the potential combined impact of clinical risk factors and family-environmental factors in adolescents with CHD.We developed a cumulative clinical risk (CCR) score by summing up binary risk factors (neonatal, cardiac, neurologic) based on clinically relevant thresholds and further investigated the role of family-environmental factors (parental education, parental mental health, and family function). Brain development in 53 adolescents with CHD who underwent infant open-heart surgery, and 75 healthy controls was studied by diffusion MRI connectomic analysis and neuropsychological assessments. The CCR score explains a great variability of the structural brain connectome. A higher CCR score was associated with lower network segregation, edge strength, and executive functioning. Edge strength was particularly reduced in an inter-frontal and fronto-parietal-thalamic network. There was no association with family-environmental factors. Poorer executive functioning was associated with lower network integration and segregation.Our results provide evidence for persisting alterations of network connectivity in adolescents with CHD – particularly in those patients who face a cumulative exposure to multiple clinical risk over time. Quantifying the cumulative load of risk early in life, may help to better predict trajectories of brain development in order to identify and support the most vulnerable patients as early as possible.

show abstract

Optimizing Neurodevelopmental Outcomes in Neonates With Congenital Heart Disease

Cited by 17 publications

References 196 publications

Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates

Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates

Biological and structural phenotypes associated with neurodevelopmental outcomes in congenital heart disease

The cumulative impact of clinical risk on brain networks and associations with executive function impairments in adolescents with congenital heart disease

Contact Info

Product

Resources

About