Current insights regarding neurological and developmental abnormalities in children and young adults with complex congenital cardiac disease

Wernovsky, Gil

doi:10.1017/s1047951105002398

Cited by 294 publications

(247 citation statements)

References 94 publications

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“…Our findings extend the knowledge of long-term neurological impairment and mental health functional morbidities in the population with CHD. Although previous studies have reported elevated risks of adverse neurodevelopmental outcomes among individuals with CHD, including increased occurrence of depression, autism, and epilepsy compared with the general population, [6][7][8]19,[32][33][34][35] our study examined an older adult population to determine the later-life consequences of this neurological outcome. Although the underlying pathophysiological mechanisms are not completely understood, the potential etiologic factors appear multifactorial and consistent with previous findings within the neurodevelopmental scientific literature.…”

Section: Discussionmentioning

confidence: 99%

“…19,[37][38][39][40] Medical and surgical management of CHD, which may result in embolic events and brain injuries inducing cerebral ischemia, hemodilution, and postoperative low-cardiac output physiology, all may negatively contribute to decreased brain reserve. 7,32,33 For example, vascular brain injuries, including clinically silent strokes, have been observed both pre-and postoperatively in infants with CHD. 6 Hypoxemia affects the same cellular pathways and may enhance this effect.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Dementia in Adults With Congenital Heart Disease

Bagge¹,

Henderson

Laursen³

et al. 2018

Circulation

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Editorial, see p XXXBACKGROUND: More children with congenital heart disease (CHD) are surviving to adulthood, and CHD is associated with risk factors for dementia. We compared the risk of dementia in CHD adults to that of the general population. METHODS:In this cohort study, we used medical registries and a medical record review covering all Danish hospitals to identify adults with CHD diagnosed between 1963 and 2012. These individuals with CHD were followed from January 1, 1981, 30 years of age, or date of first CHD registration (index date for matched members of the general population cohort) until hospital diagnosis of dementia, death, emigration, or end of study (December 31, 2012). For each individual with CHD, we identified 10 members of the general population utilizing the Danish Civil Registration System matched on sex and birth year. We computed cumulative incidences and hazard ratios (HRs) of dementia, adjusting for sex and birth year. RESULTS:The cumulative incidence of dementia was 4% by 80 years of age in 10 632 adults with CHD (46% male). The overall HR comparing adults with CHD with the general population cohort was 1.6 (95% confidence interval [CI], 1.3−2.0). The HR among individuals with CHD without extracardiac defects was 1.4 (95% CI, 1.1−1.8). Adults with mild-to-moderate CHD had an HR of 1.5 (95% CI, 1.1−2.0), whereas the HR was 2.0 (95% CI, 1.2−3.3) for severe CHD, including univentricular hearts. The HR for early onset dementia (<65 years of age) was 2.6 (95% CI, 1.8−3.8), whereas the late-onset HR was 1.3 (95% CI, 1.0−1.8).CONCLUSIONS: CHD was associated with an increased risk of dementia compared with the general population, in particular for early onset dementia. Further understanding of dementia risk in the population with CHD is a potential target for future investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of Dementia in Adults With Congenital Heart Disease

Bagge¹,

Henderson

Laursen³

et al. 2018

Circulation

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“…However, despite this increased survival, a high risk for neurodevelopmental co-morbidity persists [2]. Neurodevelopmental outcomes are characterized by a diverse spectrum of developmental delays and disabilities including impaired executive functions with the prevalence and severity increasing with the complexity of the CHD [3][4][5][6][7]. The etiology of these neurodevelopmental disorders is complex and several variables including pre-existing brain abnormalities and evolving factors in the perioperative period are believed to play a significant role [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Dehaes

Cheng

Buckley

et al. 2015

Biomed. Opt. Express

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Abstract:Congenital heart disease (CHD) patients are at risk for neurodevelopmental delay. The etiology of these delays is unclear, but abnormal prenatal cerebral maturation and postoperative hemodynamic instability likely play a role. A better understanding of these factors is needed to improve neurodevelopmental outcome. In this study, we used bedside frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) to assess cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle (SV) CHD undergoing surgery and compared them to controls. Our goals were 1) to compare cerebral hemodynamics between unanesthetized SV and healthy neonates, and 2) to determine if FDNIRS-DCS could detect alterations in cerebral hemodynamics beyond cerebral hemoglobin oxygen saturation (SO 2 ). Eleven SV neonates were recruited and compared to 13 controls. Preoperatively, SV patients showed decreased cerebral blood flow (CBF i ), cerebral oxygen metabolism (CMRO 2i ) and SO 2 ; and increased oxygen extraction fraction (OEF) compared to controls. Compared to preoperative values, unstable postoperative SV patients had decreased CMRO 2i and CBF i , which returned to baseline when stable. However, SO 2 showed no difference between unstable and stable states. Preoperative SV neonates are flow-limited and show signs of impaired cerebral development compared to controls. FDNIRS-DCS shows potential to improve assessment of cerebral development and postoperative hemodynamics compared to SO 2 alone. References and links 1. J. I. E. Hoffman and S. Kaplan, "The incidence of congenital heart disease," J. Am. Coll. Cardiol. 39, 1890-1900 A. Rappaport, and D. Wypij, "Randomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery," J. Thorac. Cardiovasc. Surg. 135, 347-54, 354.e1-4 (2008).

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“…Children with congenital heart disease (CHD) are at risk for developmental delays (DDs). [1][2][3][4] A characteristic pattern of a high prevalence of low-severity or combined disabilities in the areas of visual motor integration, language, motor skills, attention, executive function, and behavior has been described in multiple research studies. [5][6][7] Although many studies have reported outcomes near 1 year of age, no previous studies have obtained serial measures by using a consistent developmental assessment tool in young children throughout the first 3 years of life.…”

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confidence: 99%

Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children with congenital heart disease demonstrate a high prevalence of low-severity developmental problems in the areas of language, motor skills, attention, and executive function. Systematic evaluation has been recommended to promote early detection of problems and ensure appropriate intervention. WHAT THIS STUDY ADDS:This study presents results of longitudinal testing in early childhood. Developmental delays were common. Feeding difficulty and medical and genetic comorbidities increased risk for delays. Exposure to risk and prevalence of delay change over time; therefore, repeated evaluations are warranted.abstract BACKGROUND AND OBJECTIVE: Children with congenital heart disease (CHD) are at risk for developmental delay (DD). Changes in cognitive, language, and motor skills in early childhood have not been described. We report the results of a structured approach using longitudinal testing to identify problems and ensure early intervention in accordance with published guidelines.METHODS: Bayley Scales of Infant Development, Third Edition, were used to assess cognitive, language, and motor skills in 99 children with CHD. Subjects were evaluated 3 to 6 times in the first 3 years of life. DD was defined as scores .1 SD below the population mean. RESULTS:Cardiac anatomy was single ventricle (1V) in 34 subjects and 2 ventricles (2V) in 65. Medical comorbidities were present in 21% and genetic syndromes in 19%. Most subjects (75%) had DD in $1 area at $1 assessments. Subjects with 1V anatomy had equivalent outcomes to those with 2V. Cognitive and language scores declined in subjects with genetic syndromes but were stable and within the average range for subjects with 1V and 2V. Motor scores improved for subjects with 1V and 2V but remained low for those with genetic syndromes. In addition to age, need for supplemental tube feeding, longer cardiopulmonary bypass time, and shorter time since last hospitalization were significant predictors of developmental outcomes.CONCLUSIONS: DDs in young children with CHD are both common and dynamic. Providers should encourage longitudinal surveillance for children with CHD because exposure to risk and prevalence of DD change over time. Pediatrics 2014;133:e570-e577 AUTHORS:

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Current insights regarding neurological and developmental abnormalities in children and young adults with complex congenital cardiac disease

Cited by 294 publications

References 94 publications

Risk of Dementia in Adults With Congenital Heart Disease

Risk of Dementia in Adults With Congenital Heart Disease

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Risk and Prevalence of Developmental Delay in Young Children With Congenital Heart Disease

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