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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Attention deficit/hyperactivity disorder after neonatal surgery: review of the pathophysiology and risk factors
1Division of Cardiovascular Perfusion, College of Health Professions, Medical University of Charleston, Charleston, SC, USA.
Insights
Children undergoing neonatal heart surgery have higher rates of attention deficit/hyperactivity disorder (ADHD). This neurological outcome highlights the need for improved cerebral protection strategies during pediatric cardiac surgery to enhance long-term quality of life.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Disorders
- Pediatric Cardiac Surgery
Background:
- Long-term neurological deficits are increasingly evident in children surviving complex neonatal heart surgery.
- Attention deficit/hyperactivity disorder (ADHD) is a significant neurological outcome affecting quality of life for these children and their families.
- The incidence of ADHD is notably higher in pediatric cardiac surgery survivors compared to the general pediatric population.
Purpose of the Study:
- To review the pathophysiological basis of ADHD in children following cardiac surgery.
- To explore the similarities between neonatal cardiac surgical patients and preterm infants regarding ADHD risk.
- To establish ADHD as a measurable outcome for evaluating cerebral protection strategies and surgical timing in pediatric cardiac surgery.
Main Methods:
- Literature review focusing on the pathophysiological underpinnings of ADHD.
- Comparative analysis of risk factors and pathological changes in neonatal cardiac surgery patients and preterm infants.
- Examination of ADHD incidence as an indicator of neurological outcomes.
Main Results:
- Neonatal cardiac surgery patients share etiological and pathological similarities with preterm infants, both groups exhibiting increased ADHD risk.
- The higher incidence of ADHD in this population serves as an indicator of neurological impact from cardiac surgery.
- ADHD provides a measurable endpoint to assess the efficacy of intraoperative cerebral protection and procedural timing.
Conclusions:
- Reducing the incidence of ADHD in pediatric cardiac surgery survivors is a critical goal.
- Developing and evaluating novel cerebral protective strategies should prioritize minimizing long-term neurological deficits like ADHD.
- Further research into the pathophysiology linking cardiac surgery to ADHD can inform improved patient care and outcomes.
Abstract:
There are many factors that influence the long-term neurological outcomes in children following cardiac surgery. Because there is also complex interaction between these many factors, it is difficult to assess which are primary and modifiable and which can be used to make improvements in outcomes. As survival after complex neonatal heart surgery has increased, the number of children with long-term neurological deficits is becoming more evident and this affects quality of life for children and their families. One area of long-term assessment is the incidence of attention deficit/hyperactivity disorder (ADHD). The incidence rate for ADHD following pediatric cardiac surgery is significantly higher than the normal rate for children of the same age. Because this is a measureable long-term outcome, it can be used to evaluate methods for cerebral protection during surgery as well as the timing of surgical procedures to maximize cerebral oxygen levels. This paper will review the pathophysiological basis for ADHD in this population, based on the similarities between neonatal cardiac surgical patients and pre-term infants. Both populations have an increased risk for ADHD and the etiology and pathological changes in pre-term infants have been widely investigated over the past 25 years. The rate of ADHD in this population is a window into the effects of these pathological changes on long-term outcomes. Reducing the incidence of ADHD in the future in this population should be a primary goal in developing and assessing new cerebral protective strategies during cardiac surgery.
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