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

Wernovsky, Gil MD1; Licht, Daniel J. MD2

Pediatric Critical Care Medicine: August 2016 - Volume 17 - Issue 8 - p S232-S242
doi: 10.1097/PCC.0000000000000800
Organ Systems: Other Organ Systems and Systemic Disorders

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.

1Department of Pediatrics, Section of Cardiology, Florida International University, Wertheim College of Medicine, Nicklaus Children’s Hospital, Miami, FL.

2Department of Pediatrics, Section of Cardiology, Perelman School of Medicine, University of Pennsylvania, Children’s Hospital of Philadelphia Philadelphia, PA.

Dr. Licht is supported by grants from the National Institute of Neurological Disorders and Stroke (R01NS72338, R01NS060653) and support from the June and Steve Wolfson Family Foundation. He received support for article research from the National Institutes of Health and philanthropy (The S. and J. Wolfson Family). Dr. Wernovsky disclosed that he does not have any potential conflicts of interest.

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Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies