Abnormal Brain Development in Newborns with Congenital Heart Disease
Children who survive surgical repair of congenital heart defects often have abnormal neurodevelopment. In this comparison of 41 term newborns with congenital heart disease and 16 controls, abnormalities in brain maturation were present before cardiac surgery. In newborns with congenital heart diseas...
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| Published in | The New England journal of medicine Vol. 357; no. 19; pp. 1928 - 1938 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
08.11.2007
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0028-4793 1533-4406 1533-4406 |
| DOI | 10.1056/NEJMoa067393 |
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| Abstract | Children who survive surgical repair of congenital heart defects often have abnormal neurodevelopment. In this comparison of 41 term newborns with congenital heart disease and 16 controls, abnormalities in brain maturation were present before cardiac surgery.
In newborns with congenital heart disease, abnormalities in brain maturation were present before cardiac surgery.
In the United States, severe congenital heart disease is a common cause of childhood morbidity, occurring in 6 to 8 infants per 1000 live births.
1
Although most forms of congenital heart disease are now amenable to early surgical repair, deficits that impair widespread neurodevelopmental domains are identified in up to half of childhood survivors: fine motor skills, visuospatial skills, and cognition, including memory, attention, and higher-order language skills.
2
–
5
Despite the importance of these functional impairments at a public health level, the underlying basis of the deficits is largely unknown.
Although studies of brain injury in newborns with congenital heart . . . |
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| AbstractList | Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease before they underwent heart surgery.BACKGROUNDCongenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease before they underwent heart surgery.We studied 41 term newborns with congenital heart disease--29 who had transposition of the great arteries and 12 who had single-ventricle physiology--with the use of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before cardiac surgery. We calculated the ratio of N-acetylaspartate to choline (which increases with brain maturation), the ratio of lactate to choline (which decreases with maturation), average diffusivity (which decreases with maturation), and fractional anisotropy of white-matter tracts (which increases with maturation). We compared these findings with those in 16 control newborns of a similar gestational age.METHODSWe studied 41 term newborns with congenital heart disease--29 who had transposition of the great arteries and 12 who had single-ventricle physiology--with the use of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before cardiac surgery. We calculated the ratio of N-acetylaspartate to choline (which increases with brain maturation), the ratio of lactate to choline (which decreases with maturation), average diffusivity (which decreases with maturation), and fractional anisotropy of white-matter tracts (which increases with maturation). We compared these findings with those in 16 control newborns of a similar gestational age.As compared with control newborns, those with congenital heart disease had a decrease of 10% in the ratio of N-acetylaspartate to choline (P=0.003), an increase of 28% in the ratio of lactate to choline (P=0.08), an increase of 4% in average diffusivity (P<0.001), and a decrease of 12% in white-matter fractional anisotropy (P<0.001). Preoperative brain injury, as seen on MRI, was not significantly associated with findings on MRS or DTI. White-matter injury was observed in 13 newborns with congenital heart disease (32%) and in no control newborns.RESULTSAs compared with control newborns, those with congenital heart disease had a decrease of 10% in the ratio of N-acetylaspartate to choline (P=0.003), an increase of 28% in the ratio of lactate to choline (P=0.08), an increase of 4% in average diffusivity (P<0.001), and a decrease of 12% in white-matter fractional anisotropy (P<0.001). Preoperative brain injury, as seen on MRI, was not significantly associated with findings on MRS or DTI. White-matter injury was observed in 13 newborns with congenital heart disease (32%) and in no control newborns.Term newborns with congenital heart disease have widespread brain abnormalities before they undergo cardiac surgery. The imaging findings in such newborns are similar to those in premature newborns and may reflect abnormal brain development in utero.CONCLUSIONSTerm newborns with congenital heart disease have widespread brain abnormalities before they undergo cardiac surgery. The imaging findings in such newborns are similar to those in premature newborns and may reflect abnormal brain development in utero. Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease before they underwent heart surgery. We studied 41 term newborns with congenital heart disease--29 who had transposition of the great arteries and 12 who had single-ventricle physiology--with the use of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before cardiac surgery. We calculated the ratio of N-acetylaspartate to choline (which increases with brain maturation), the ratio of lactate to choline (which decreases with maturation), average diffusivity (which decreases with maturation), and fractional anisotropy of white-matter tracts (which increases with maturation). We compared these findings with those in 16 control newborns of a similar gestational age. As compared with control newborns, those with congenital heart disease had a decrease of 10% in the ratio of N-acetylaspartate to choline (P=0.003), an increase of 28% in the ratio of lactate to choline (P=0.08), an increase of 4% in average diffusivity (P<0.001), and a decrease of 12% in white-matter fractional anisotropy (P<0.001). Preoperative brain injury, as seen on MRI, was not significantly associated with findings on MRS or DTI. White-matter injury was observed in 13 newborns with congenital heart disease (32%) and in no control newborns. Term newborns with congenital heart disease have widespread brain abnormalities before they undergo cardiac surgery. The imaging findings in such newborns are similar to those in premature newborns and may reflect abnormal brain development in utero. Children who survive surgical repair of congenital heart defects often have abnormal neurodevelopment. In this comparison of 41 term newborns with congenital heart disease and 16 controls, abnormalities in brain maturation were present before cardiac surgery. In newborns with congenital heart disease, abnormalities in brain maturation were present before cardiac surgery. In the United States, severe congenital heart disease is a common cause of childhood morbidity, occurring in 6 to 8 infants per 1000 live births. 1 Although most forms of congenital heart disease are now amenable to early surgical repair, deficits that impair widespread neurodevelopmental domains are identified in up to half of childhood survivors: fine motor skills, visuospatial skills, and cognition, including memory, attention, and higher-order language skills. 2 – 5 Despite the importance of these functional impairments at a public health level, the underlying basis of the deficits is largely unknown. Although studies of brain injury in newborns with congenital heart . . . Background Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease before they underwent heart surgery. Methods We studied 41 term newborns with congenital heart disease -- 29 who had transposition of the great arteries and 12 who had single-ventricle physiology -- with the use of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before cardiac surgery. We calculated the ratio of N -acetylaspartate to choline (which increases with brain maturation), the ratio of lactate to choline (which decreases with maturation), average diffusivity (which decreases with maturation), and fractional anisotropy of white-matter tracts (which increases with maturation). We compared these findings with those in 16 control newborns of a similar gestational age. Results As compared with control newborns, those with congenital heart disease had a decrease of 10% in the ratio of N -acetylaspartate to choline (P=0.003), an increase of 28% in the ratio of lactate to choline (P=0.08), an increase of 4% in average diffusivity (P<0.001), and a decrease of 12% in white-matter fractional anisotropy (P<0.001). Preoperative brain injury, as seen on MRI, was not significantly associated with findings on MRS or DTI. White-matter injury was observed in 13 newborns with congenital heart disease (32%) and in no control newborns. Conclusions Term newborns with congenital heart disease have widespread brain abnormalities before they undergo cardiac surgery. The imaging findings in such newborns are similar to those in premature newborns and may reflect abnormal brain development in utero. [PUBLICATION ABSTRACT] |
| Author | Ferriero, Donna M McQuillen, Patrick S Karl, Tom Miller, Steven P Hamrick, Shannon Xu, Duan Glidden, David V Charlton, Natalie Vigneron, Daniel B Azakie, Anthony Barkovich, A. James |
| Author_xml | – sequence: 1 givenname: Steven P surname: Miller fullname: Miller, Steven P – sequence: 2 givenname: Patrick S surname: McQuillen fullname: McQuillen, Patrick S – sequence: 3 givenname: Shannon surname: Hamrick fullname: Hamrick, Shannon – sequence: 4 givenname: Duan surname: Xu fullname: Xu, Duan – sequence: 5 givenname: David V surname: Glidden fullname: Glidden, David V – sequence: 6 givenname: Natalie surname: Charlton fullname: Charlton, Natalie – sequence: 7 givenname: Tom surname: Karl fullname: Karl, Tom – sequence: 8 givenname: Anthony surname: Azakie fullname: Azakie, Anthony – sequence: 9 givenname: Donna M surname: Ferriero fullname: Ferriero, Donna M – sequence: 10 givenname: A. James surname: Barkovich fullname: Barkovich, A. James – sequence: 11 givenname: Daniel B surname: Vigneron fullname: Vigneron, Daniel B |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19216185$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/17989385$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| Copyright | Copyright © 2007 Massachusetts Medical Society. All rights reserved. 2007 INIST-CNRS Copyright 2007 Massachusetts Medical Society. |
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| Keywords | Medicine Brain Newborn diseases Development Cardiovascular disease Congenital cardiopathy Encephalon |
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| Snippet | Children who survive surgical repair of congenital heart defects often have abnormal neurodevelopment. In this comparison of 41 term newborns with congenital... Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of... Background Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as... |
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| SubjectTerms | Babies Biological and medical sciences Brain Brain - anatomy & histology Brain - embryology Brain - metabolism Brain - pathology Brain Diseases - diagnosis Brain Diseases - etiology Cardiovascular disease Case-Control Studies Congenital diseases Diffusion Magnetic Resonance Imaging Female General aspects Gestational Age Heart Defects, Congenital - complications Heart Ventricles - abnormalities Humans Imaging, Three-Dimensional Infant, Newborn Magnetic Resonance Imaging Magnetic Resonance Spectroscopy Male Medical sciences Prenatal development Prospective Studies Transposition of Great Vessels - complications |
| Title | Abnormal Brain Development in Newborns with Congenital Heart Disease |
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