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Impact of perinatal management on neurodevelopmental outcomes in congenital heart disease
Neeta Sethi1, Jessica L Carpenter2, Mary T Donofrio3
1Duke Children's Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, NC, USA.
Insights
Prenatal diagnosis of congenital heart disease (CHD) may improve perinatal care and preoperative status, potentially reducing brain injury and enhancing neurodevelopmental outcomes in neonates. This focus is crucial for CHD survivors.
Area of Science:
- Pediatric Cardiology
- Neonatal Neurology
- Developmental Neuroscience
Background:
- Neonatal surgical correction of congenital heart disease (CHD) has seen reduced mortality due to improved cardiopulmonary bypass and perioperative care.
- Focus is shifting towards improving neurodevelopmental outcomes in CHD survivors.
- Cerebral abnormalities in CHD patients often predate surgical repair, indicating prenatal factors are critical.
Purpose of the Study:
- To review the impact of prenatal diagnosis of CHD on perinatal care.
- To examine how prenatal diagnosis influences the preoperative clinical status of neonates.
- To explore the potential of prenatal diagnosis in mitigating cerebral injury and improving long-term neurodevelopmental outcomes.
Main Methods:
- Literature review on the effects of prenatal diagnosis of CHD.
- Analysis of the relationship between prenatal diagnosis, perinatal care, and preoperative status.
- Assessment of the influence on cerebral injury and neurodevelopmental outcomes.
Main Results:
- Prenatal diagnosis of CHD can optimize perinatal care and preoperative clinical status.
- Early identification may mitigate the severity of cerebral abnormalities.
- Optimized perinatal management is linked to better long-term neurodevelopmental trajectories in infants with CHD.
Conclusions:
- Prenatal diagnosis of CHD is a critical factor in optimizing perinatal care and preoperative status.
- This approach holds significant potential for reducing brain injury and improving neurodevelopmental outcomes in neonates with CHD.
- Further research into prenatal interventions is warranted to enhance long-term brain health in CHD survivors.
Abstract:
With advancements in cardiopulmonary bypass technique and perioperative care, there has been a progressive decline in mortality associated with neonatal surgical correction of congenital heart disease (CHD). Thus, there is now increased focus on improving neurodevelopmental outcomes in CHD survivors. While the cause of these neurodevelopmental impairments is multifactorial, there is increasing evidence that structural and functional cerebral abnormalities are present before cardiac corrective repair. This suggests that in addition to patient specific risk factors, underlying cardiac physiology and clinical hemodynamics are critical to brain health and development. Prenatal diagnosis of CHD and subsequent optimization of perinatal care may therefore be important modifiable factors for long-term neurodevelopmental outcome. This article reviews the impact that prenatal diagnosis of CHD has on perinatal care and the preoperative clinical status of a neonate, as well as the potential influence this may have on lessening the degree of cerebral injury and long-term neurodevelopmental impairments.
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