Postoperative brain volumes are associated with one-year neurodevelopmental outcome in children with severe congenital heart disease

Abstract

Children with congenital heart disease (CHD) remain at risk for neurodevelopmental impairment despite improved perioperative care. Our prospective cohort study aimed to determine the relationship between perioperative brain volumes and neurodevelopmental outcome in neonates with severe CHD. Pre- and postoperative cerebral MRI was acquired in term born neonates with CHD undergoing neonatal cardiopulmonary bypass surgery. Brain volumes were measured using an atlas prior-based automated method. One-year neurodevelopmental outcome was assessed with the Bayley-III. CHD infants (n = 77) had lower pre- and postoperative total and regional brain volumes compared to controls (n = 44, all p < 0.01). CHD infants had poorer cognitive and motor outcome (p ≤ 0.0001) and a trend towards lower language composite score compared to controls (p = 0.06). Larger total and selected regional postoperative brain volumes were found to be associated with better cognitive and language outcomes (all p < 0.04) at one year. This association was independent of length of intensive care unit stay for total, cortical, temporal, frontal and cerebellar volumes. Therefore, reduced cerebral volume in CHD neonates undergoing bypass surgery may serve as a biomarker for impaired outcome.

Investigating altered brain development in infants with congenital heart disease using tensor-based morphometry

“…Previous studies have shown reductions in total brain volume, regional brain volumes [23][24][25][26][27][28][29] and biometric measurements of brain size 30,31 , and expansions in extra-axial CSF volume 24 in infants with CHD prior to surgery. Similar to our previous reports in a subsample of this cohort, we observed smaller total brain, white matter, deep grey matter and regional cortical grey matter volumes in infants with CHD compared to controls 24,25 .…”

“…Reduced subcortical grey matter and increased CSF volumes in the neonatal period are associated with impaired behavioural state regulation and visual orienting in infants with CHD prior to surgery 10 . In addition, smaller cortical grey matter, white matter, cerebellar 28 , basal ganglia and thalami, and brainstem 38 volumes in newborns with CHD after surgery are associated with poorer cognitive and language outcome scores 28 and below-average IQ 38 in later infancy 28 and childhood 38 . These relationships persist into adolescence where reduced white matter, cerebellar 39 , and hippocampal volumes 39,40 are associated with impaired total IQ and other measures of cognitive, motor and executive functions 39,40 .…”

“…in total and regional brain volumes, compared to healthy controls [22][23][24][25][26][27][28][29][30][31][32][33][34] . These abnormalities are evident prior to surgery and have been associated with reduced cerebral oxygen delivery 24,25,33 .…”

Delayed maturation of the structural brain connectome in neonates with congenital heart disease

“…1 ). Neuroimaging and neurodevelopmental outcomes in subsamples of this cohort were published previously ( Bertholdt et al , 2014 ; Claessens et al , 2016 ; Jakab et al , 2019 ; Meuwly et al , 2019 ).…”

“…Although a link of aberrant brain development and injury with neurodevelopmental outcome has been demonstrated ( Andropoulos et al , 2014 ; Claessens et al , 2018 ; Meuwly et al , 2019 ), the complex phenotype of later neurodevelopmental impairments in CHD children remains insufficiently explained. Thus, more advanced neuroimaging analyses considering the complex network of the brain beyond specific structure and function mapping are needed to better capture adverse brain development in CHD neonates ( Peyvandi et al , 2016 ).…”