New concepts in predicting, evaluating, and managing neurodevelopmental outcomes in children with congenital heart disease

Abstract

Over the last two decades advances in congenital heart surgery, pediatric cardiology, and pediatric intensive care have dramatically increased the survival of infants with critical congenital heart disease (CHD). Survivors often experience neurodevelopmental deficits and behavioral and emotional problems. These complications often have a profound impact on quality of life in this high-risk population. This review will focus on the most significant and innovative studies that have been published over the last 18 months that focus on predicting, evaluating, and managing neurodevelopmental outcomes in children with CHD. Recent reports demonstrate new potential predictors of worse neurodevelopmental outcome, including abnormal fetal cerebrovascular resistance, brain biomarkers, and abnormalities in electroencephalogram (EEG) during the perioperative period, and new stratification schemata. In addition, a new evidence-based scientific statement from the American Heart Association (AHA) and American Academy of Pediatrics (AAP) describing how to evaluate and manage neurodevelopmental outcomes in children and adolescents with CHD and novel interventions to improve neurodevelopmental outcomes will be reviewed. The literature reviewed reveals new intervention opportunities to improve neurodevelopmental outcome in the fetus (cerebrovascular resistance), during the perioperative period (brain biomarkers and EEG), and through the utilization of new stratification schemata. The new AHA/AAP guidelines on the evaluation and management of neurodevelopmental outcomes create the opportunity to identify and treat a significant population of survivors with neurodevelopmental deficits with novel interventions.