The neuro-heart program: The importance of early postoperative screening

Abstract

Introduction

Recent studies highlight a high prevalence of difficulties at school and neurodevelopmental disorders in children with operated congenital heart disease.

Objective

The objective of this study was to evaluate the application of this program 2 years after its introduction.

Methods

A systematic screening program for neurodevelopmental disorders was recently developed within our institution for every patient who had cardiac surgery before the age of one year. The “neuro-heart program” involves an antenatal, preoperative and postoperative assessment allowing the child to be assigned to pathway A (screening for neurodevelopmental disorders by parental questionnaires at key ages), pathway B (reassessment necessary at 3 months) or pathway C (specific follow-up at CAMPS with support from physiotherapist, speech therapist, psychomotor therapists, etc.).

Results

Between October 2020 and November 2022, 78 patients operated under extracorporeal circulation before the age of one year were included in the “neuro-heart program”. Concerning antenatal evaluation: 43 children benefited from an antenatal diagnosis, including 30 with complex or ductal-dependent heart disease but only 10 brain MRIs were performed. Concerning the preoperative evaluation: only 14/31 patients with duct-dependent heart disease benefited from a preoperative neurological evaluation while 38/48 with non-duct-dependent heart disease benefited from it. Concerning the postoperative neurological assessment: 100% of patients were pointed towards a care pathway: 33 patients were referred to pathway A, 6 to pathway B and 39 to pathway C. Concerning the children in pathway C, we found a prevalence of genetic syndrome (P = 0.003) and a higher age at surgery (P = 0.0008) compared to the children of pathway A. There was no significant difference between the 2 groups concerning pre- or postoperative electroencephalogram anomalies and pre- or postoperative brain MRI anomalies.

Conclusion

Preoperative neurological assessment methods are sometimes difficult, especially in duct-dependent patients. The implementation of a screening and monitoring program for neurodevelopmental disorders can be carried out postoperatively.