A guide to prenatal counselling regarding neurodevelopment in congenital heart disease.

Advances in cardiac surgical techniques taking place over the past 50 years have resulted in the vast majority of children born with congenital cardiac malformations now surviving into adulthood. As the focus shifts from survival to the functional outcomes of our patients, it is increasingly being recognized that a significant proportion of patients undergoing infant cardiac repair experience adverse neurodevelopmental outcomes. The etiology of abnormal brain development in the setting of congenital heart disease is poorly understood, complex and likely multifactorial. Furthermore, the efficacy of therapies available for the learning disabilities, attention deficit and hyperactivity disorders and other neurodevelopmental deficits complicating congenital heart disease are currently uncertain. This situation presents a challenge for prenatal counselling, as current antenatal testing does not usually provide prognostic information regarding the likely neurodevelopmental trajectories of individual patients. However, we believe it is important for parents to be informed about potential issues with child development when a new diagnosis of congenital heart disease is disclosed. Parents deserve a comprehensive and thoughtful approach to this subject, which conveys the uncertainties involved in predicting the severity of any developmental disorders encountered, while emphasizing the improvements in outcomes that have already been achieved in infants with congenital heart disease. A balanced approach to counselling should also discuss what local arrangements are in place for neurodevelopmental follow-up. This review presents an up-to-date overview of neurodevelopmental outcomes in patients with congenital heart disease, providing possible approaches to communicating this information to parents during prenatal counselling in a sensitive and accurate manner. This article is protected by copyright. All rights reserved.