Strategies to Improve Neurologic Outcomes in Neonatal Cardiac Surgery

Abstract Purpose of Review Neonates with congenital heart disease (CHD) necessitating repair during infancy are at risk for adverse neurodevelopmental outcomes throughout their lifespan. The etiology of brain injury in this population is multifactorial and includes both modifiable and non-modifiable risk factors. We aim to review modifiable risk factors and evidence-based interventions aimed at improving short- and long- term neurodevelopmental outcomes. Recent Findings Despite increasing focus in recent years on improving neurodevelopmental outcomes in individuals with CHD, there remains a paucity of literature on interventions that improve neurodevelopmental outcomes. This is likely due to the complex interactions between the many risk factors, some of which are non-modifiable, for brain injury in this population. The heterogeneity of each specific cardiac lesion and the differential risk they may confer to brain injury make studying this population challenging. Potential interventions to improve outcomes span a wide variety of clinical care settings and require collaboration among a large multidisciplinary team, including the prenatal care team, cardiac intensive care team, operative team (cardiac surgery, anesthesia, perfusion), neurology, outpatient cardiology, outpatient primary care pediatricians, and developmental specialists. Summary Improving neurodevelopmental outcomes in neonates with CHD is multifaceted, and there likely is no one intervention that will unequivocally improve outcomes. Improving outcomes will require a multidisciplinary team spanning prenatal, inpatient, and outpatient care. More data are needed to identify modifiable risk factors and targeted interventions that will improve both short- and long- term neurodevelopmental outcomes.