Brain injury and development in newborns with critical congenital heart disease

Dimitropoulos, Anastasia; McQuillen, Patrick S.; Sethi, Viyeka; Moosa, Alisha; Chau, Vann; Xu, Duan; Brant, Rollin; Azakie, Anthony; Campbell, Andrew; Barkovich, A. James; Poskitt, Kenneth J.; Miller, Steven P.

doi:10.1212/wnl.0b013e31829bfdcf

Cited by 204 publications

(186 citation statements)

References 38 publications

(58 reference statements)

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“…This might be related to already described abnormalities of brain microstructure and metabolism. [35][36][37] However, 40% of presumed causative events took place beyond first CCS, and in this group, single ventricle defects were overrepresented.…”

Section: Figurementioning

confidence: 87%

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Ricci¹,

Andersen

Joffe

et al. 2015

Pediatrics

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BACKGROUND AND OBJECTIVES: Little is known about chronic neuromotor disability (CND) including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery (CCS). We sought to determine the frequency and presentation of CND in this population while exploring potentially modifiable acute care predictors.METHODS: This prospective follow-up study included 549 children after CCS requiring cardiopulmonary bypass at #6 weeks of age. Groups included those with only 1 CCS, mostly biventricular CHD, and those with .1 CCS, predominantly single ventricle defects. At 4.5 years of age, 420 (94.6%) children received multidisciplinary assessment. Frequency of CND is given as percentage of assessed survivors. Predictors of CND were analyzed using multiple logistic regression analysis.RESULTS: CND occurred in 6% (95% confidence interval [CI] 3.7%-8.2%) of 4.5-year survivors; for 1 CCS, 4.2% (CI 2.3%-6.1%) and .1, 9.8% (CI 7%-12.6%). CND presentation showed: hemiparesis, 72%; spasticity, 80%; ambulation, 72%; intellectual disability, 44%; autism, 16%; epilepsy, 12%; permanent vision and hearing impairment, 12% and 8%, respectively. Overall, 32% of presumed causative events happened before first CCS. Independent odds ratio for CND are age (days) at first CCS, 1.08 (CI 1.04-1.12; P , .001); highest plasma lactate before first CCS (mmol/L), 1.13 (CI 1.03-1.23; P = 0.008); and .1 CCS, 3.57 (CI 1.48-8.9; P = .005).CONCLUSIONS: CND is not uncommon among CCS survivors. The frequency of associated disabilities characterized in this study informs pediatricians caring for this vulnerable population. Shortening the waiting period and reducing preoperative plasma lactate levels at first CCS may assist in reducing the frequency of CND. WHAT'S KNOWN ON THIS SUBJECT:Neurodevelopmental outcomes after cardiac surgery in early life provide critical information for understanding and improving care. Studies show these children are at risk for arterial ischemic stroke and acquired brain injury; further characterization of motor impairment is needed. WHAT THIS STUDY ADDS:This study focuses on the presence of chronic neuromotor disabilities including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery, providing information on the frequency, characteristics, and predictors that may assist in prevention.

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Section: Figurementioning

confidence: 87%

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Ricci¹,

Andersen

Joffe

et al. 2015

Pediatrics

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“…For example, third trimester fetuses with SV physiology and transposition of the great arteries, had smaller brain volumes with lower metabolic N-acetyl aspartate (NAA) levels, suggesting a lower density of neurons and synapses [26]. Similarly, postnatally in the preoperative period, lower NAA levels have been observed in SV neonates along with lower brain maturation scores and immature white matter microstructure [17,62].…”

Section: Discussionmentioning

confidence: 99%

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Dehaes

Cheng

Buckley

et al. 2015

Biomed. Opt. Express

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Abstract:Congenital heart disease (CHD) patients are at risk for neurodevelopmental delay. The etiology of these delays is unclear, but abnormal prenatal cerebral maturation and postoperative hemodynamic instability likely play a role. A better understanding of these factors is needed to improve neurodevelopmental outcome. In this study, we used bedside frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) to assess cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle (SV) CHD undergoing surgery and compared them to controls. Our goals were 1) to compare cerebral hemodynamics between unanesthetized SV and healthy neonates, and 2) to determine if FDNIRS-DCS could detect alterations in cerebral hemodynamics beyond cerebral hemoglobin oxygen saturation (SO 2 ). Eleven SV neonates were recruited and compared to 13 controls. Preoperatively, SV patients showed decreased cerebral blood flow (CBF i ), cerebral oxygen metabolism (CMRO 2i ) and SO 2 ; and increased oxygen extraction fraction (OEF) compared to controls. Compared to preoperative values, unstable postoperative SV patients had decreased CMRO 2i and CBF i , which returned to baseline when stable. However, SO 2 showed no difference between unstable and stable states. Preoperative SV neonates are flow-limited and show signs of impaired cerebral development compared to controls. FDNIRS-DCS shows potential to improve assessment of cerebral development and postoperative hemodynamics compared to SO 2 alone. References and links 1. J. I. E. Hoffman and S. Kaplan, "The incidence of congenital heart disease," J. Am. Coll. Cardiol. 39, 1890-1900 A. Rappaport, and D. Wypij, "Randomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery," J. Thorac. Cardiovasc. Surg. 135, 347-54, 354.e1-4 (2008).

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“…29 Follow-up postnatal MR imaging studies and neurodevelopmental outcome assessments are needed to determine whether the prenatal findings described herein are transient or persistent in nature and their impact on long-term outcome. These studies are currently underway.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Spectrum of In Utero Structural Brain Abnormalities in Fetuses with Complex Congenital Heart Disease

Brossard‐Racine

Plessis

Vézina³

et al. 2014

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Brain injury is a major complication in neonates with complex congenital heart disease. Preliminary evidence suggests that fetuses with congenital heart disease are at greater risk for brain abnormalities. However, the nature and frequency of these brain abnormalities detected by conventional fetal MR imaging has not been examined prospectively. Our primary objective was to determine the prevalence and spectrum of brain abnormalities detected on conventional clinical MR imaging in fetuses with complex congenital heart disease and, second, to compare the congenital heart disease cohort with a control group of fetuses from healthy pregnancies.

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Brain injury and development in newborns with critical congenital heart disease

Cited by 204 publications

References 38 publications

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Chronic Neuromotor Disability After Complex Cardiac Surgery in Early Life

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Prevalence and Spectrum of In Utero Structural Brain Abnormalities in Fetuses with Complex Congenital Heart Disease

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