The American Heart Association has released a scientific statement on the management of neurodevelopmental outcomes in patients with congenital heart disease. Circulation.

This statement addresses best practices for neuroprotection, risk stratification, assessment, and management of patients with congenital heart disease and updates the 2012 statement on assessment and management of neurodevelopmental outcomes in children with congenital heart disease. This is what I did.

The updated statement includes revised risk categories for developmental delay or disability, factors that increase neurodevelopmental risk, and algorithms for high-risk patients.

Among important updates, the statement proposes three categories of patients with congenital heart disease who are at high risk for developmental delay or disability. Risk categories 1 and 2 remain unchanged, but risk category 3 includes those who do not meet the criteria for categories 1 or 2 but who require intervention or hospitalization secondary to congenital heart disease in infancy, childhood, or adolescence. now includes individuals with one or more of the following factors: Increases neurodevelopmental risk.

Recent studies have shown that many factors, including genetic factors, fetal and perinatal factors, surgical and perioperative factors, social and familial factors, early growth factors, and developmental factors, are important in patients with congenital heart disease. It has been suggested that it may increase the neurodevelopmental risk of These factors are associated with abnormal brain development and brain damage, which can negatively impact neurodevelopmental, psychosocial, and physical outcomes and reduce quality of life.

A new section on emerging risk factors is provided, including the effects of altered cardiovascular physiology on intrauterine cerebral blood flow and development, abnormal placental development, prolonged or repeated anesthetic exposure, These include exposure to neurotoxic chemicals, multiple interventions, and pediatric complications.

The updated statement also includes a new section on promising neuroprotective strategies. According to the authors, neuroprotection begins with prenatal detection of congenital heart disease, and planning for term birth is key to reducing the additive effects of preterm birth on brain development and brain damage. Family-centered developmental care may provide neuroprotection for infants hospitalized with congenital heart disease.

Updated algorithms are provided for referral, assessment, and management of high-risk individuals. These patients should be referred for developmental evaluation, and high-risk infants and young children should also be referred for early intervention, according to the statement. Patients with significant cognitive delays, sensory and motor impairments, and language impairments may require an individualized approach, and clinicians must understand the influence of the patient’s culture and language. “Given long-standing racial disparities in standardized test performance, there is a need to identify and implement testing methods and practices that reduce bias and inequity in assessment and decision-making,” the authors state. .

Areas of age-based developmental assessment are grouped into patients from birth to 5 years of age, school age and adolescence, and adulthood. Low-risk children should receive developmental monitoring and screening based on the 2020 American Academy of Pediatrics Clinical Report, and recommendations for screening for anxiety, depression, and suicide risk apply to patients with congenital heart disease, according to the statement. It also applies to High-risk patients should be referred for periodic reassessment at the next developmental stage, or sooner if necessary.

Another new section covers neuropsychological deficits in adults. In addition to treating the metabolic causes of neuropsychological symptoms, drugs should be evaluated to identify polydrug interactions and interactions that may affect neuropsychological functioning. Psychological interventions may help reduce co-occurring anxiety and mood disorders.

“Neurodevelopmental research and clinical care must be prioritized over the next decade to improve lifelong neurodevelopmental outcomes and health-related quality of life for patients with congenital heart disease,” the authors wrote. is writing.