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In children born with severe heart defect, surgical management has little effect on neuro outcomes
Date:4/5/2012

neurodevelopmental outcomes. "Between Norwood discharge and age 12 months, a greater number of complications were also associated with worse development, a novel finding that highlights ongoing brain vulnerability and opportunities for intervention," said Newburger. Longer recovery times and prolonged mechanical ventilation may involve other factors during hospitalization, such as adverse events, low cardiac output, poor feeding or comorbidities.

"The finding that postnatal factors had only modest effects on neurodevelopment is consistent with growing evidence that the risk for adverse neurodevelopmental outcomes begins in the prenatal period," added Gaynor. Patients with HLHS have a high rate of abnormal cerebral development and smaller head size, suggesting that genetic factors and epigenetic changes contribute to brain abnormalities. Researchers have identified abnormalities in fetal cerebral blood flow and in brain metabolism and microstructure, all indicative of brain immaturity in fetuses and neonates with this heart defect. These delays in brain maturation, said Gaynor, may increase the infant's vulnerability to circulatory injury in the brain during the operative period.

Further studies may reveal interventions that improve neurodevelopmental outcomes in these children, conclude the authors. In addition to discouraging elective deliveries before 39 weeks, they suggest evaluating further measures to protect the brain from hemodynamic instability before and after the surgery, and improving developmental support after the infant is discharged following the Norwood procedure.


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Contact: Joey McCool Ryan
McCool@email.chop.edu
267-426-6070
Children's Hospital of Philadelphia
Source:Eurekalert

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