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Sood E, Newburger JW, Anixt JS, Cassidy AR, Jackson JL, Jonas RA, Lisanti AJ, Lopez KN, Peyvandi S, Marino BS. 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 2024; 149:e997-e1022. [PMID: 38385268 DOI: 10.1161/cir.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.
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Thomas AR, Levy PT, Donofrio MT, Law B, Joynt C, Gupta R, Elshenawy S, Reed D, Pavlek LR, Shepherd J, Gowda SH, Johnson BA, Abdulhayoglu E, Valencia E, Guseh S, Ball MK, Ali N. Call to action: prioritizing delivery room care for neonates with critical congenital heart disease. J Perinatol 2024; 44:321-324. [PMID: 37980393 DOI: 10.1038/s41372-023-01828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Alyssa R Thomas
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Brenda Law
- Division of Neonatology, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada
| | - Chloe Joynt
- Division of Neonatology, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada
| | - Ruby Gupta
- Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA
| | - Summer Elshenawy
- Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle Reed
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Leeann R Pavlek
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer Shepherd
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sharada H Gowda
- Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Beth Ann Johnson
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Elisa Abdulhayoglu
- Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonore Valencia
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie Guseh
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molly K Ball
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Noorjahan Ali
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
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Dischinger AN, Li JS, Mulder H, Spears T, Chiswell KE, Hoffman TM, Hartman RJ, Walsh MJ, Sang CJ, Sarno LA, Paolillo JA, Welke K, D'Ottavio A, Sethi NJ. Impact of Prenatal Diagnosis of Critical Congenital Heart Disease on Preoperative and Postoperative Outcomes. Pediatr Cardiol 2023; 44:1520-1528. [PMID: 37289278 DOI: 10.1007/s00246-023-03197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
The objective of this study was to assess the relationship of prenatal diagnosis of critical congenital heart disease (CHD) to preoperative and postoperative patient findings. Retrospective analysis of neonates with critical CHD who underwent cardiothoracic surgery at one of four centers in North Carolina between 2008 and 2013. Surgical data collected by sites for submission to the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and the North Carolina CHD Lifespan Database were queried. There were 715 patients with STS records; 558 linked to the NC-CHD database. Patients with prenatal diagnosis had a lower incidence of preoperative risk factors, including need for mechanical ventilation and presence of shock. However, prenatally diagnosed patients had worse short-term outcomes, including higher operative mortality, higher incidence of select postoperative complications, and longer LOS. There was no difference in one-year mortality. Our findings are consistent with current literature which suggests that prenatal diagnosis of critical CHD is associated with a more optimized preoperative clinical status. However, we found that patients with prenatal diagnoses had less favorable postoperative outcomes. This needs to be investigated further, but may be secondary to patient-specific factors, such as CHD disease severity.
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Affiliation(s)
- Ashley N Dischinger
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, 2301 Erwin Road, #7506, Durham, NC, USA.
| | - Jennifer S Li
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, 2301 Erwin Road, #7506, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tracy Spears
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Karen E Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Timothy M Hoffman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert J Hartman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael J Walsh
- Department of Pediatrics, Division of Pediatric Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Charlie J Sang
- Departmart of Pediatrics, Division of Pediatric Cardiology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Lauren A Sarno
- Departmart of Pediatrics, Division of Pediatric Cardiology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Joseph A Paolillo
- Atrium Health Levine Children's Congenital Heart Center, Charlotte, NC, USA
| | - Karl Welke
- Atrium Health Levine Children's Congenital Heart Center, Charlotte, NC, USA
| | - Alfred D'Ottavio
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Neeta J Sethi
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, 2301 Erwin Road, #7506, Durham, NC, USA
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Paul EA, Cohen J, Geiger MK. Cardiac problems in the fetus: a review for pediatric providers. Curr Opin Pediatr 2023; 35:523-530. [PMID: 37466056 DOI: 10.1097/mop.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide pediatric providers with a review of the diagnosis and management of fetal cardiac disease in the current era. RECENT FINDINGS Prenatal detection of congenital heart disease (CHD) has improved but is still imperfect. In experienced hands, fetal echocardiography can detect severe CHD as early as the first trimester and a majority of more subtle conditions in the second and third trimesters. Beyond detection, a prenatal diagnosis allows for lesion-specific counseling for families as well as for development of a multidisciplinary perinatal management plan, which may involve in-utero treatment. Given the diversity of cardiac diagnoses and the rarity of some, collaborative multicenter fetal cardiac research has gained momentum in recent years. SUMMARY Accurate diagnosis of fetal cardiac disease allows for appropriate counseling, pregnancy and delivery planning, and optimization of immediate neonatal care. There is potential for improving fetal CHD detection rates. Fetal interventions are available for certain conditions, and fetal and pediatric cardiac centers have developed management plans specific to the expected postnatal physiology.
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Affiliation(s)
- Erin A Paul
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Levy P, Thomas AR, Law BHY, Joynt C, Gupta R, Elshenawy S, Reed D, Pavlek LR, Shepherd J, Gowda S, Johnson BA, Ball M, Ali N. Multicentre study protocol comparing standard NRP to deveLoped Educational Modules for Resuscitation of Neonates in the Delivery Room with Congenital Heart Disease (LEARN-CHD). BMJ Open 2023; 13:e067391. [PMID: 37019485 PMCID: PMC10083808 DOI: 10.1136/bmjopen-2022-067391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Infants born with critical congenital heart defects (CCHDs) have unique transitional pathophysiology that often requires special resuscitation and management considerations in the delivery room (DR). While much is known about neonatal resuscitation of infants with CCHDs, current neonatal resuscitation guidelines such as the neonatal resuscitation programme (NRP) do not include algorithm modifications or education specific to CCHDs. The implementation of CCHD specific neonatal resuscitation education is further hampered by the large number of healthcare providers (HCPs) that need to be reached. Online learning modules (eLearning) may provide a solution but have not been designed or tested for this specific learning need. Our objective in this study is to design targeted eLearning modules for DR resuscitation of infants with specific CCHDs and compare HCP knowledge and team performance in simulated resuscitations among HCPs exposed to these modules compared with directed CCHD readings. METHODS AND ANALYSIS In a prospective multicentre trial, HCP proficient in standard NRP education curriculum are randomised to either (a) directed CCHD readings or (b) CCHD eLearning modules developed by the study team. The efficacy of these modules will be evaluated using (a) individual preknowledge/postknowledge testing and (b) team-based resuscitation simulations. ETHICS AND DISSEMINATION This study protocol is approved by nine participating sites: the Boston Children's Hospital Institutional Review Board (IRB-P00042003), University of Alberta Research Ethics Board (Pro00114424), the Children's Wisconsin IRB (1760009-1), Nationwide Children's Hospital IRB (STUDY00001518), Milwaukee Children's IRB (1760009-1) and University of Texas Southwestern IRB (STU-2021-0457) and is under review at following sites: University of Cincinnati, Children's Healthcare of Atlanta, Children's Hospital of Los Angeles and Children's Mercy-Kansas City. Study results will be disseminated to participating individuals in a lay format and presented to the scientific community at paediatric and critical care conferences and published in relevant peer-reviewed journals.
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Affiliation(s)
- Philip Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa R Thomas
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda Hiu Yan Law
- Department of Pediatrics, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Chloe Joynt
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ruby Gupta
- Department of Pediatrics, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Summer Elshenawy
- Department of Pediatrics, Emory University School of Medicine Atlanta, Atlanta, Georgia, USA
| | - Danielle Reed
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Leeann R Pavlek
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jennifer Shepherd
- Department of Pediatrics, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Sharada Gowda
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Beth Ann Johnson
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Molly Ball
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Noorjahan Ali
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Słodki M, Copel JA, Rizzo G, Araujo Junior E, Axt-Fliedner R, Abuhamad A, Simpson LL, Lee W, DeVore G, Bahado-Singh R, Preis K, Respondek-Liberska M. Fetal Cardiology: Is It Time to Establish a Separate Independent Medicine Subspeciality? Pediatr Cardiol 2022; 43:1676-1677. [PMID: 35606573 DOI: 10.1007/s00246-022-02936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Maciej Słodki
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
| | - Joshua A Copel
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università' Roma Tor Vergata, Rome, Italy
| | - Edward Araujo Junior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Justus-Liebig University, Giessen, Germany
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Lynn L Simpson
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Greggory DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ray Bahado-Singh
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Krzysztof Preis
- Department of Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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Management of Hypertrophic Cardiomyopathy in a Newborn with Dextro-Transposition of the Great Arteries. Pediatr Cardiol 2022; 43:926-929. [PMID: 35307751 DOI: 10.1007/s00246-022-02874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Impaired maternal glucose metabolism during pregnancy can have significant effects on the cardiovascular system of the developing fetus. Early in pregnancy the teratogenic effects may lead to structural heart defects, while later in gestation a form of hypertrophic cardiomyopathy can develop due to overgrowth driven by fetal hyperinsulinism. We describe an infant with the uncommon combination of both dextro-transposition of the great arteries and hypertrophic cardiomyopathy. We emphasize the importance of a longitudinal multi-disciplinary approach, from fetal diagnosis to post-operative management, that allowed for an excellent outcome in this rare combination of severe cardiac malformations.
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