Children with heart defects need early evaluation for related disordersJuly 31, 2012
Children born with a congenital heart defect should receive early evaluation, prompt treatment and ongoing follow-up for related developmental disorders affecting brain function, according to a new American Heart Association scientific statement published in Circulation.
Each year in the United States, congenital heart defects - present at birth - affect approximately 36,000 infants, or nine out of every 1,000. Adult survivors now number between 1 and 3 million.
Medical advances help most infants born with a congenital heart defect survive into adulthood. However, survivors with complex heart problems are at a greater risk for developmental issues compared to heart-healthy children, which may stem from the heart defect, an underlying genetic variation, medical treatments or the day-to-day psychological stress of living with an ongoing, serious disease.
"If your child fits the high-risk criteria, go to the physician who coordinates your child's care to obtain evaluations for neurodevelopmental, psychosocial, and behavioral and emotional issues," said Bradley S. Marino, M.D., M.P.P, M.S.C.E., co-chair for the scientific statement's writing group and associate professor of pediatrics at the University of Cincinnati College of Medicine.
"Your child's cardiologist should continue to handle the physical issues related to your child's heart disease, but other caregivers need to join your child's 'medical home' to ensure the best ongoing, comprehensive care," said Marino who is also director of the Heart Institute Research Core and the Heart Institute Neurodevelopmental Clinic at Cincinnati Children's Hospital Medical Center. A medical home is usually the child's primary care provider.
Developmental disorders among children with congenital heart defects may manifest in childhood or adolescence as school difficulties, poor social skills, speech and language problems, attention, behavior and emotional issues and physical limitations. These developmental disorders can be identified and managed through continuous surveillance, appropriate screening, early evaluation, periodic re-evaluation, and continuous, comprehensive treatment coordinated by a central care provider. Treatment may include special education classes, tutoring, psychological, physical, and occupational and speech therapies.
In addition to assessing risk level and referring high-risk patients for further developmental and medical evaluation, other recommendations include:
- Establish a "medical home," usually the primary care provider, to coordinate care between various specialists.
- Each time your child visit's their "medical home," their risk of developmental disorders should be reassessed because risk level may change over time.
- If your child is considered at high-risk, they may be referred for early intervention even before a developmental disorder is formally diagnosed.
- For children with congenital heart disease deemed high-risk, periodic re-evaluation for developmental disorders is recommended throughout infancy and childhood at 12 to 24 months, 3 to 5 years and 11-12 years of age.
- If your child is high-risk, they may benefit from higher-education or vocational counseling when they are a young adult.
The statement identifies, for the first time, conditions that increase the risk for these developmental disorders among survivors, including open heart surgery in infancy, having a congenital heart defect that results in the child being chronically "blue", or a combination of congenital heart disease and one of the following issues: premature birth; developmental delay as a baby; suspected genetic abnormality or syndrome; history of mechanical support to help the heart; heart transplantation; a history of cardiopulmonary resuscitation; prolonged hospitalization during the child's heart care; seizures related to heart surgery; and brain abnormalities noted on brain imaging.
"If we identify developmental problems earlier, we're going to help prevent issues from coming up in school that prevent these children from achieving their fullest potential," Marino said. "In the past, we were happy if they survived. Now, we want them to survive and thrive."
American Heart Association
Related Congenital Heart Defect Current Events and Congenital Heart Defect News Articles
CNIC researchers identify a new signaling mechanism implicated in congenital aortic valve disease
Researchers at the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) have demonstrated the crucial role of the NOTCH signaling pathway in the development of a fundamental heart structure, the heart valves.
Scientists elucidate genetic underpinnings of congenital heart disease
Congenital heart disease is the most common birth defect and the leading cause of all infant deaths in the United States.
New findings on embryonic heart valves may prevent congenital heart defects in newborns
Cornell biomedical engineers have discovered natural triggers that could reduce the chance of life-threatening, congenital heart defects among newborn infants. Those triggers can override developmental, biological miscues, leading to proper embryonic heart and valve formation.
Device-assisted feeding and poor growth in newborns with CHD may lead to poor neurodevelopment
Newborns with a congenital heart defect (CHD) often need advanced medical care to survive, leaving them vulnerable to cognitive delays. Various factors, like prematurity, length of hospital stay, cardiac arrest, amongst others, contribute to these delays.
Preeclampsia increases risk of heart defects in infants
Pregnant women with preeclampsia have a higher risk of delivering an infant with a congenital heart defect.
Surgeons refine procedure for life-threatening congenital heart defect
Children born with the major congenital heart defect hypoplastic left heart syndrome (HLHS) often must undergo a series of corrective surgeries beginning at birth.
Blood markers could help predict outcome of infant heart surgery
The study, published today in the journal Critical Care Medicine and carried out at Royal Brompton Hospital, followed children undergoing surgery for congenital heart disease, and found that by analysing metabolites in the blood -- molecules created as a result of metabolism -- it was possible to predict a child's clinical outcome.
Exercise for older mouse mothers lowers risk of heart defects in babies
In people, a baby's risk of congenital heart defects is associated with the age of the mother. Risk goes up with increasing age. Newborn mice predisposed to heart defects because of genetic mutations show the same age association.
Congenital heart defects affects long-term developmental outcome
Approximately one percent of all newborns in Switzerland are diagnosed with a congenital heart defect, roughly half of them require open heart surgery.
Environmental toxins linked to heart defects
Children's congenital heart defects may be associated with their mothers' exposure to specific mixtures of environmental toxins during pregnancy, according to research presented at the American Heart Association's Scientific Sessions 2013.
More Congenital Heart Defect Current Events and Congenital Heart Defect News Articles