Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease

• Published in: Journal of the American College of Cardiology Vol. 71; no. 18; pp. 1986 - 1996
• Main Authors: Peyvandi, Shabnam, Chau, Vann, Guo, Ting, Xu, Duan, Glass, Hannah C., Synnes, Anne, Poskitt, Kenneth, Barkovich, A. James, Miller, Steven P., McQuillen, Patrick S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 08.05.2018; Elsevier Limited
• Subjects: Arteries; Birth weight; Brain Injuries - diagnostic imaging; Brain Injuries - etiology; Brain injury; Brain research; Cardiac Surgical Procedures - adverse effects; Cardiology; Cardiovascular; Cardiovascular disease; Congenital diseases; congenital heart disease; Coronary artery disease; Education; Female; Heart diseases; Hispanic people; Humans; Infant, Newborn; Infants; Longitudinal Studies; Magnetic resonance imaging; Male; Medical imaging; Neonates; Neurodevelopmental Disorders - diagnostic imaging; Neurodevelopmental Disorders - etiology; neurodevelopmental outcomes; Neuroimaging; Newborn babies; NMR; Nuclear magnetic resonance; Parent educational background; Perioperative Care; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Prospective Studies; Pulmonary arteries; Socioeconomic factors; Stroke; Studies; Substantia alba; Transposition; Transposition of Great Vessels - surgery; Traumatic brain injury; Ventricle; Ventricles (cerebral); MRI; CI; UCSF; SVP; BIS; brain injury; WMI; d-TGA; MDI; neurodevelopmental outcomes; BAS; PDI; ND; UBC; congenital heart disease; IVH; FA; CHD; Psychomotor Development Index; magnetic resonance imaging; University of British Columbia; neurodevelopmental; intraventricular hemorrhage; Mental Development Index; single-ventricle physiology; balloon atrial septostomy; brain injury severity; University of California-San Francisco Benioff Children’s Hospital; d-transposition of the great arteries; fractional anisotropy; confidence interval; white matter injury
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2018.02.068

Brain injury (BI) is reported in 60% of newborns with critical congenital heart disease as white matter injury (WMI) or stroke. Neurodevelopmental (ND) impairments are reported in these patients. The relationship between neonatal BI and ND outcome has not been established. This study sought to determine the association between peri-operative BI and ND outcomes in infants with single ventricle physiology (SVP) and d-transposition of the great arteries (d-TGA). Term newborns with d-TGA and SVP had pre-operative and post-operative brain magnetic resonance imaging and ND outcomes assessed at 12 and 30 months with the Bayley Scales of Infant Development-II. BI was categorized by the brain injury severity score and WMI was quantified by volumetric analysis. A total of 104 infants had follow-up at 12 months and 70 had follow-up at 30 months. At 12 months, only clinical variables were associated with ND outcome. At 30 months, subjects with moderate-to-severe WMI had significantly lower Psychomotor Development Index (PDI) scores (13 points lower) as compared with those with none or minimal WMI for d-TGA and SVP (p = 0.03 and p = 0.05, respectively) after adjusting for various factors. Quantitative WMI volume was likewise associated. Stroke was not associated with outcome. The Bland-Altman limits of agreement for PDI scores at 12 and 30 months were wide (−40.3 to 31.2) across the range of mean PDI values. Increasing burden of WMI is associated with worse motor outcomes at 30 months for infants with critical congenital heart disease, whereas no adverse association was seen between small strokes and outcome. These results support the utility of neonatal brain magnetic resonance imaging in this population to aid in predicting later outcomes and the importance of ND follow-up beyond 1 year of age. [Display omitted]