Fetal cerebrovascular resistance and neonatal EEG predict 18‐month neurodevelopmental outcome in infants with congenital heart disease

Abstract

Objectives The purpose of this study was to investigate early markers of risk for neurobehavioral compromise in congenital heart disease (CHD) survivors. Methods Fetuses < 24 wks gestational age (GA) were enrolled in this prospective pilot study for serial Doppler assessment of the middle cerebral and umbilical artery. The cerebral-to-placental resistance ratio (CPR) and MCA pulsatility index (PI) z-scores for GA were calculated. After birth, subjects underwent high-density (128-lead) electroencephalogram (EEG) and beta frequency (12–24Hz) band EEG power, a measure of local neural synchrony, was analyzed. Neurodevelopment was assessed at 18-months with the Bayley Scales of Infant Development III (BSID). Results 13 subjects were enrolled: 4 with hypoplastic left heart syndrome (HLHS), 4 with transposition of the great arteries (TGA), and 5 with tetralogy of Fallot (TOF). Compared with subjects with normal CPR, those with CPR<1(N=7) had lower mean BSID cognitive scores (91.4±4.8 vs. 99.2±3.8, p=.008). Fetal MCA PI z-score also correlated with BSID cognitive score (r=.589, p=0.044) as did neonatal EEG left frontal polar (r=.58, p=.037) and left frontal (r=.77,p=.002) beta power. Furthermore, fetal Doppler measures were associated with EEG power: fetuses with CPR<1 had lower left frontal polar (t=2.36, p=.038) and left frontal (t=2.85, p=.016) beta power as newborns compared with fetuses with normal CPR, and fetal MCA PI z-score correlated with neonatal EEG left frontal polar (r=.596, p=.04) and left frontal (r=.598, p=.04) beta power. Conclusions In CHD fetuses with HLHS, TGA, and TOF, abnormal cerebrovascular resistance predicted decreased neonatal EEG left frontal beta power and lower 18-mo cognitive development scores.

Diastolic Dysfunction and Cerebrovascular Redistribution Precede Overt Recipient Twin Cardiomyopathy in Early-Stage Twin-Twin Transfusion Syndrome

“…Additionally, studies linking cerebral Doppler abnormalities to impaired neurodevelopment in the growth-restricted population focus on third-trimester fetuses, with evaluation a few weeks from delivery being most predictive of outcomes, and our subjects were studied in the second trimester. A study by Williams et al 48 found cerebroplacental Doppler abnormalities before 23 weeks' gestation to be predictive of impaired postnatal neurodevelopment in fetuses with congenital heart disease. Aghajanian et al 36 evaluated MCA PI in fetuses with TTT, and found that RTs had lower MCA PI Z scores compared with DTs, which was found to increase significantly after laser therapy.…”

Congenital cardiac anomalies and white matter injury

“…Doppler ultrasound is an emerging technique that can predict brain volumetric abnormalities and neurodevelopmental outcomes of fetuses with certain CHDs [15,45–50]. This noninvasive technique offers important information regarding fetal hemodynamics by measuring the velocity of blood flow through cerebral arteries.…”

Detección precoz de trastornos del neurodesarrollo en los primeros años de vida en niños con cardiopatías congénitas

“…Williams et al (2012b) señalan que con este tipo de intervención se reducen las tasas de mortalidad en estos infantes pero que, a su vez, aumenta la probabilidad de que aparezcan morbilidades en el neurodesarrollo a largo plazo, según defiende Schaefer et al (2013).…”

“…Junto a ellos, Williams et al (2012b) recomiendan y consideran que es conveniente que estos niños reciban AT, pues varios autores han encontrado en recién nacidos a término con cardiopatías congénitas, patrones de desarrollo similares a los niños prematuros (Esquivel et al 2013). Estos últimos reciben AT (GAT, 2000) mientras que los primeros no, a pesar de que les beneficiaría, según indican Williams et al (2012b).…”