Psychomotorische und kognitive Entwicklung und Lebensqualität bei Kindern und Jugendlichen mit angeborenem Herzfehler

Zusammenfassung

Kinder mit angeborenem Herzfehler (AHF) haben ein signifikantes Risiko für psychomotorische und kognitive Entwicklungsstörungen mit negativen Auswirkungen auf die psychosoziale Situation, akademische Leistung und Lebensqualität. Wichtigste Risikofaktoren sind angeborene Merkmale wie genetische Anomalien, Art und Schweregrad des AHF und sozioökonomische Faktoren. Pränatal können durch Hypoperfusion oder Hypoxie Reifungs- und Entwicklungsstörungen des Gehirns entstehen mit der Folge postnataler Läsionen der vermehrt vulnerablen Hirnsubstanz und neurologischer Entwicklungsstörungen. Die Hochrisiko-Gruppe umfasst vor allem Säuglinge, bei denen eine Operation am offenen Herzen erforderlich ist. Es bestehen spezifische phänotypische Merkmale der Entwicklung in verschiedenen Lebensaltern: in der frühen Kindheit motorische Defizite und sprachliche Artikulationsprobleme; bei Schulkindern eine Beeinträchtigung von Sprache, Aufmerksamkeit, Gedächtnis, visuell-räumlichen Fähigkeiten, exekutiven Funktionen und motorischen Fähigkeiten, oft in Verbindung mit akademischen Defiziten sowie emotionalen oder sozialen Problemen; im Jugendalter exekutive, psychosoziale sowie psychiatrische Störungen und eine eingeschränkte Lebensqualität; im Erwachsenenalter neurokognitive, psychosoziale sowie Probleme des Selbstmanagements und der beruflichen Perspektive. Körperliche und soziale Funktionsfähigkeit, psychomotorische Entwicklung und psychisches Befinden erweisen sich als Schlüsselfaktoren für die Lebensqualität. Die Deutsche Gesellschaft für Pädiatrische Kardiologie fordert für die Hochrisikogruppe der im Säuglingsalter operierten Kinder mit AHF ausführliche serielle neuropsychologische Untersuchungen im Alter von 2 und 5 Jahren, vor Pubertät und vor Beginn des Erwachsenenalters, um frühzeitig Teilleistungsstörungen erkennen und behandeln zu können.

Abstract

Children with congenital heart disease (CHD) are at significant risk of psychomotor and cognitive developmental disorders, with negative effects on psychosocial and academic performance and quality of life. Innate characteristics such as genetic abnormalities, type and severity of CHD and socioeconomic factors are the most important risk factors. Prenatally, hypoperfusion or hypoxia can cause developmental and maturation disorders of the brain, thus promoting postpartum lesions of the more vulnerable brain substance and neurodevelopmental disorders. The high-risk group includes primarily infants requiring open heart surgery. Specific phenotypic characteristics of development emerge at different ages: in early childhood motor and linguistic articulation deficits; at school age impaired speech and language, attention, memory, visual-spatial, executive, and motor skills, often associated with academic deficits, and emotional or social issues; in adolescence executive, psychosocial and psychiatric disorders and impaired quality of life; in adulthood, neurocognitive, psychosocial and problems of self-management and professional perspective. Physical and social functioning, psychomotor development and mental health are key factors for quality of life. The German Society of Pediatric Cardiology demands detailed serial neuropsychological examinations at the age of 2 and 5 years, before puberty and before adulthood, for the high-risk group of children with CHD operated on in infant age in order to detect and to treat partial performance disorders at an early stage.

Schlüsselwörter

angeborener Herzfehler - Enzephalopathie - Herzchirurgie - Entwicklungsmerkmale - Risikofaktoren - Lebensqualität

Key words

congenital heart defect - encephalopathy - open heart surgery - neurodevelopmental patterns - risk factors - quality of life

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