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Review
. 2016 Aug;17(8 Suppl 1):S232-42.
doi: 10.1097/PCC.0000000000000800.

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

Gil Wernovsky  1 , Daniel J Licht
Affiliations
Review

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

Gil Wernovsky et al. Pediatr Crit Care Med. 2016 Aug.

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 prenatal, pre-, intra-, and postoperative factors, neurodevelopmental outcomes, and therapeutic strategies for the timely intervention and prevention of neurologic injury.

Data source: MEDLINE and 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 ICU 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 postoperative 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.

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Conflict of interest statement

Conflict of interest: Dr. Wernovsky disclosed that he does not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
Current model relating measured neurodevelopmental outcomes at various timepointswith potential etiologic factors in children with complex congenital heart disease. ICU=Intensive Care Unit
Figure 2
Figure 2
a. The potential interactions between complex congenital heart and brain disease, its treatment, and parental and patient outcomes in (a) the infant. ADHD=attention deficit hyperactivity disorder b. The potential interactions between complex congenital heart and brain disease, its treatment, and parental and patient outcomes in (b) the child. ADHD=attention deficit hyperactivity disorder
Figure 2
Figure 2
a. The potential interactions between complex congenital heart and brain disease, its treatment, and parental and patient outcomes in (a) the infant. ADHD=attention deficit hyperactivity disorder b. The potential interactions between complex congenital heart and brain disease, its treatment, and parental and patient outcomes in (b) the child. ADHD=attention deficit hyperactivity disorder
Figure 3
Figure 3
The progression of multiple factors related to adverse neurodevelopment and ‘the fragile child’ following a prolonged intensive care unit stay
See this image and copyright information in PMC

References

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