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Optimizing Neurodevelopmental Outcomes in Neonates With Congenital Heart Disease
Cynthia M Ortinau1,2, Christopher D Smyser1,3,4,2, Lindsay Arthur5
1Departments of Pediatrics.
Insights
Infants with congenital heart disease (CHD) often experience neurodevelopmental issues. This review covers brain abnormalities, genetics, and best practices in cardiac neurodevelopmental care to improve outcomes.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Science
- Clinical Neurology
Background:
- Congenital heart disease (CHD) is frequently associated with long-term neurodevelopmental impairment.
- Over half of infants with complex CHD exhibit neurodevelopmental, neurocognitive, or psychosocial dysfunction.
- Addressing these neurological sequelae is crucial for improving quality of life.
Purpose of the Study:
- To review current literature on brain abnormalities impacting neurodevelopment in children with CHD.
- To examine the influence of genetics on neurodevelopmental outcomes in this population.
- To outline best practices in neonatal neurocritical care, including developmental care and parental support.
Main Methods:
- Literature review of recent studies on CHD and neurodevelopment.
- Analysis of research on genetic and environmental factors.
- Synthesis of best practices in neonatal neurocritical care and family support frameworks.
Main Results:
- Identifies specific brain abnormalities linked to neurodevelopmental deficits in CHD.
- Highlights the significant role of genetic factors in neurodevelopmental trajectories.
- Emphasizes the importance of developmental care and parental support in neonatal neurocritical care.
Conclusions:
- Cardiac neurodevelopmental care is essential for improving outcomes in infants with CHD.
- A comprehensive approach integrating neurocritical care, genetic insights, and family support is needed.
- Frameworks for infrastructure and resources are vital for supporting CHD families throughout care.
Abstract:
Neurodevelopmental impairment is a common and important long-term morbidity among infants with congenital heart disease (CHD). More than half of those with complex CHD will demonstrate some form of neurodevelopmental, neurocognitive, and/or psychosocial dysfunction requiring specialized care and impacting long-term quality of life. Preventing brain injury and treating long-term neurologic sequelae in this high-risk clinical population is imperative for improving neurodevelopmental and psychosocial outcomes. Thus, cardiac neurodevelopmental care is now at the forefront of clinical and research efforts. Initial research primarily focused on neurocritical care and operative strategies to mitigate brain injury. As the field has evolved, investigations have shifted to understanding the prenatal, genetic, and environmental contributions to impaired neurodevelopment. This article summarizes the recent literature detailing the brain abnormalities affecting neurodevelopment in children with CHD, the impact of genetics on neurodevelopmental outcomes, and the best practices for neonatal neurocritical care, focusing on developmental care and parental support as new areas of importance. A framework is also provided for the infrastructure and resources needed to support CHD families across the continuum of care settings.
