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Children with heart defects need early evaluation for related disorders

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 an American Heart Association scientific statement published recently in Circulation.1

“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 Professor Bradley S Marino, co-chair for the scientific statement’s writing group (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 Prof Marino who is also director of the Heart Institute Research Core and the Heart Institute Neurodevelopmental Clinic at Cincinnati Children’s Hospital Medical Center.

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 a child visit’s their “medical home,” their risk of developmental disorders should be reassessed as risk level may change over time.
  • If a 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 a child is high-risk, they may benefit from higher-education or vocational counseling when they are a young adult.

The statement identifies 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 hospitalisation 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,” Prof Marino said. “In the past, we were happy if they survived. Now, we want them to survive and thrive”.

References

1. Marino BS, Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management. Circulation 2012;126http://dx.doi.org/10.1161/CIR.0b013e318265ee8a

Published on: August 24, 2012

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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