Interplay of brain structure and function in neonatal congenital heart disease

Abstract

ObjectiveTo evaluate whether structural and microstructural brain abnormalities in neonates with congenital heart disease (CHD) correlate with neuronal network dysfunction measured by analysis of EEG connectivity.MethodsWe studied a prospective cohort of 20 neonates with CHD who underwent continuous EEG monitoring before surgery to assess functional brain maturation and network connectivity, structural magnetic resonance imaging (MRI) to determine the presence of brain injury and structural brain development, and diffusion tensor MRI to assess brain microstructural development.ResultsNeonates with MRI brain injury and delayed structural and microstructural brain development demonstrated significantly stronger high‐frequency (beta and gamma frequency band) connectivity. Furthermore, neonates with delayed microstructural brain development demonstrated significantly weaker low‐frequency (delta, theta, alpha frequency band) connectivity. Neonates with brain injury also displayed delayed functional maturation of EEG background activity, characterized by greater background discontinuity.InterpretationThese data provide new evidence that early structural and microstructural developmental brain abnormalities can have immediate functional consequences that manifest as characteristic alterations of neuronal network connectivity. Such early perturbations of developing neuronal networks, if sustained, may be responsible for the persistent neurocognitive impairment prevalent in adolescent survivors of CHD. These foundational insights into the complex interplay between evolving brain structure and function may have relevance for a wide spectrum of neurological disorders manifesting early developmental brain injury.

Probabilistic tractography‐based thalamic parcellation in healthy newborns and newborns with congenital heart disease

“…Although the precise cause of these findings cannot be determined in this pilot study, disorganized connections or a more disperse pattern of thalamocortical connectivity are possible. Birca and colleagues reported decreased low-frequency electroencephalographic connectivity in association with lower FA measurements in the cerebral white matter of neonates with CHD, which supports the hypothesis that our observations may indeed represent abnormalities in emerging cerebral connectivity (45). …”

“…Birca et al reported decreased lowfrequency electroencephalographic connectivity in association with lower FA measurements in the cerebral white matter of neonates with CHD, which supports the hypothesis that our observations may indeed represent abnormalities in emerging cerebral connectivity. 45 Considering that all CHD neonates in this study were imaged prior to surgery and that there was no acute brain injury at the time of the scan, the observed differences probably developed prenatally. Berman et al reported higher ADC in the thalami of fetuses with CHD imaged during the third trimester relative to controls neonates, which supports that at least in some neonates abnormalities in thalamic microstructure and/or development arise prenatally.…”

Annual Research Review: Not just a small adult brain: understanding later neurodevelopment through imaging the neonatal brain

“…Recently, Birca et al. () have shown an interesting association between microstructural brain abnormalities and functional connectivity measured with EEG in patients with CHD. However, further studies are required in order to thoroughly characterise brain connectivity in these infants, and to determine whether there is a pattern of atypical early connectivity that can predict later altered neurodevelopment.…”

Neurodevelopmental Abnormalities and Congenital Heart Disease

“…There is now evidence that perturbations in structural and microstructural brain development can result in alterations in neuronal network connectivity in neonates with CHD 67 . Graphic analysis to acquired DTI data recently revealed that differences in the connectome mediate poor neurocognitive function seen in adolescents with d-transposition of the great arteries (d-TGA) repaired during infancy 68 .…”