NEUROLOGIC COMPLICATIONS OF CARDIAC DISEASE IN THE NEWBORN

Advances in the management of infants with congenital heart disease ha ve lead to a striking decrease in mortality. The most dramatic impact has been in the newborn infant with complex and previously lethal hear t disease. These heart lesions have become amenable to corrective proc edures in the newborn period because of the development of support tec hniques such as low-flow cardiopulmonary bypass and deep hypothermic c irculatory arrest. However, these techniques have demonstrated their o wn inherit risk for neurologic injury. Consequently, in recent years t here has emerged a growing population of infants surviving congenital heart disease only to manifest subsequent neurologic complications ori ginating from injury in the hemodynamically unstable preoperative peri od or periods of intraoperative hypoperfusion. The preservation of neu rology function has emerged as the next frontier in the management of congenital heart disease. Finally, neurologic dysfunction in the newbo rn with cardiac disease may reflect associated brain malformations or the combined cardiac and brain manifestations of inherited metabolic d isease. The clinical features and mechanisms of brain injury are discu ssed for these structural and metabolic cardiac diseases presenting in the newborn infant.