Andersons pediatric cardiology 2283
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FIG.89.2 Congenitalheartdisease(CHD)algorithmforsurveillance,
screening,evaluation,andmanagementofdevelopmentaldisordersand
disabilities.ND,neurodevelopmental.aThedecisionofscreeningversus
evaluationisatthediscretionofthemedicalhomeprovider.bPerAmerican
AssociationofPediatricsguidelines,developmentalscreeningshouldtake
placeat9,18,30,and48monthsofage.Screeningforautismspectrum
disordersshouldalsooccuratthe18-and24-monthvisits.cReferralsfor
earlyinterventionmaybemadeifthechildis<5yearsornotyetin
kindergarten.dPeriodicevaluationshouldtakeplaceat12to24months,3
to5years,and11to12yearsofage.Ifapatientisidentifiedashighriskat
12years,anevaluationplanshouldbedeterminedatthediscretionofthe
medicalhomeprovider.
Insummary,childrenwithCHDareatriskforneurodevelopmentaldelaysand
psychosocialimpairment.Aspecificdevelopmentalprofilehasbeenidentified
thatischaracterizedbymotorandcognitivedelaysandimpairedlanguage
acquisitioninyoungchildrenandimpairedexecutivefunction,visual-motorspatialintegration,andbehavioral/mentalhealthchallengesaschildrenreach
adolescence.Childrenwhohaveundergoneinfantopenheartsurgery,suffer
fromchroniccyanosis,orhaveadditionalhigh-riskcomorbiditiessuchas
prematurityorunderlyinggeneticconditionsareathighestrisk.Becausethese
problemstypicallymanifestasmilddelaysinmultipledomains,specialized
screening/testingbyaclinicianwithexpertiseinpatientswithCHDis
recommended.Promptidentificationofdevelopmentalissuesandaggressive
interventionarenecessarytopromotethebestfunctionaloutcomeinthese
patients.
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