Home Medizin Verständnis und Bewältigung neurologischer Entwicklungsherausforderungen bei angeborenen Herzfehlern

Verständnis und Bewältigung neurologischer Entwicklungsherausforderungen bei angeborenen Herzfehlern

von NFI Redaktion

According to a new scientific statement published by the American Heart Association, over a decade of new insights into neurodevelopmental risks in individuals with congenital heart disease have changed the mindset about who is most at risk and which factors affect neurological development, learning, emotions, and behavior today in the flagship peer-reviewed journal of the association, Circulation.

Congenital heart defects, defined as structural abnormalities of the heart or surrounding blood vessels that occur before birth, are the most common types of birth defects. While treatment advances have helped more than 90% of people with congenital heart defects in industrialized countries reach adulthood, the risk of neurological developmental problems in individuals with more severe congenital heart defects has not significantly improved.

The new scientific statement, „Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk Stratification, Evaluation, and Management,“ describes significant progress in understanding the impact of congenital heart disease on a person’s development, learning, emotions, and behaviors throughout childhood and into adulthood.

Neurodevelopmental disorders are among the most common and sustained complications faced by people with congenital heart disease. These difficulties can impair a person’s ability to function well in school, at work, or in social situations and can impact health-related quality of life through childhood and into adulthood. It is important for medical professionals and individuals with congenital heart defects, as well as their families, to understand how common neurological developmental disorders are. It is also important to understand why a person with a congenital heart defect is at high risk for these difficulties and how these challenges can be prevented or treated,“ says Erica Sood, Ph.D., Deputy Chair of the Writing Group, Lead Research Scientist, and Child Psychologist at Nemours Children’s Health, Delaware Valley.

The statement provides updated guidelines for medical professionals to recognize which patients are at high risk for neurodevelopmental disorders and which type of assessments may be helpful in better understanding these difficulties. Optimizing neural developmental outcomes through clinical care and research is becoming increasingly important as more patients reach adulthood.

Key findings of the statement include:

  • The risk-stratification algorithm for individuals with congenital heart defects in high or low risk for developmental delays or disorders has been revised to account for the latest research findings.
  • The statement proposes that medical professionals sequentially review three risk categories: Risk category 1 includes patients with a history of infant heart operationswith cardiopulmonary bypass. Risk category 2 includes individuals with a history of chronic cyanosis, individuals with bluish or purplish discoloration due to low blood oxygen levels, who did not have heart surgery with cardiopulmonary bypass in infancy. For risk category 3, there are two criteria. The first criterion for risk category 3 is a history of a procedure or hospital admission as a result of congenital heart disease in infancy, childhood, or adolescence. The second criterion is the presence of one or more factors known to increase the risk of neurological development.
  • The statement includes an updated list of factors known to increase the risk of neurological development, including genetic, fetal, and perinatal impacts, surgical aspects of treatment and care, socio-economic and family influences, and factors related to growth and development.
  • There is a new section on emerging risk factors such as abnormal placental development, prolonged or repeated anesthesia exposure, and exposure to neurotoxic chemicals.
  • Moreover, there is a new section on neuroprotective strategies, including prenatal recognition of congenital heart defects, monitoring of brain blood flow and oxygen delivery, and functional support measures such as physical therapy, occupational therapy, and speech pathology.
  • The statement provides updated information on referring for age-based assessment of individuals with congenital heart defects at high risk for developmental delays or disorders. The statement cites the Cardiac Neurodevelopmental Outcome Collaborative guidelines, which recommend that children with congenital heart disease at high risk for developmental delays or disorders receive neurological development assessments throughout infancy, childhood, and adolescence.
  • The statement also includes updated information on managing developmental delays or disorders in infants, children, and adolescents, as well as a new section on managing neuropsychological deficits in adults.

„Removing obstacles that individuals with congenital heart defects and their families often face in accessing support and services for neurological development, and ensuring adequate research funding, are priority areas for future policies,“ said Bradley S. Marino, MD, Chairman of the Writing Group, MPP, MSCE, MBA, FAHA, Chief of Pediatric Cardiology and Cardiovascular Medicine at the Cleveland Clinic Children’s. „Further research will lead to a better understanding of how neurological developmental disorders related to congenital heart defects can be prevented and treated, ultimately improving the neurological developmental outcomes and health-related quality of life of individuals with congenital heart defects throughout their lifespan.“

This scientific statement was developed by the volunteer writing group on behalf of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young and the Council on Cardiovascular and Stroke Nursing of the American Heart Association. Scientific statements of the American Heart Association promote greater awareness of cardiovascular and stroke issues and help facilitate informed healthcare decisions. Scientific statements provide an overview of what is currently known about a topic and areas where further research is needed. While scientific statements inform the development of guidelines, they do not provide treatment recommendations. The American Heart Association’s guidelines contain the official recommendations of the Association for clinical practice.

Source:

American Heart Association

Journal reference:

Sood, E., et al. (2024) Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk Stratification, Evaluation, and Management: A Scientific Statement from the American Heart Association. Circulation. doi.org/10.1161/CIR.0000000000001211.

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