Onset of brain injury in infants with prenatally diagnosed congenital heart disease.

Mirthe J Mebius,Tjark Ebels,Catherina M Bilardo,Martin C J Kneyber,Elisabeth M W Kooi,Marco Modestini,Arend F Bos,Rolf M F Berger,Emma Duerden

doi:10.1371/journal.pone.0230414

Mirthe J Mebius, Tjark Ebels + Show 7 more

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https://doi.org/10.1371/journal.pone.0230414

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Abstract

BackgroundThe exact onset of brain injury in infants with congenital heart disease (CHD) is unknown. Our aim was, therefore, to assess the association between prenatal Doppler flow patterns, postnatal cerebral oxygenation and short-term neurological outcome.MethodsPrenatally, we measured pulsatility indices of the middle cerebral (MCA-PI) and umbilical artery (UA-PI) and calculated cerebroplacental ratio (CPR). After birth, cerebral oxygen saturation (rcSO2) and fractional tissue oxygen extraction (FTOE) were assessed during the first 3 days after birth, and during and for 24 hours after every surgical procedure within the first 3 months after birth. Neurological outcome was determined preoperatively and at 3 months of age by assessing general movements and calculating the Motor Optimality Score (MOS).ResultsThirty-six infants were included. MOS at 3 months was associated with MCA-PI (rho 0.41, P = 0.04), UA-PI (rho -0.39, P = 0.047, and CPR (rho 0.50, P = 0.01). Infants with abnormal MOS had lower MCA-PI (P = 0.02) and CPR (P = 0.01) and higher UA-PI at the last measurement (P = 0.03) before birth. In infants with abnormal MOS, rcSO2 tended to be lower during the first 3 days after birth, and FTOE was significantly higher on the second day after birth (P = 0.04). Intraoperative and postoperative rcSO2 and FTOE were not associated with short-term neurological outcome.ConclusionIn infants with prenatally diagnosed CHD, the prenatal period may play an important role in developmental outcome. Additional research is needed to clarify the relationship between preoperative, intra-operative and postoperative cerebral oxygenation and developmental outcome in infants with prenatally diagnosed CHD.

Highlights

Up to 50% of infants with congenital heart disease (CHD) have neurodevelopmental impairments later in life [1]
Motor Optimality Score (MOS) at 3 months was associated with MCA-PI, UA-PI
In infants with abnormal MOS, rcSO2 tended to be lower during the first 3 days after birth, and fractional tissue oxygen extraction (FTOE) was significantly higher on the second day after birth (P = 0.04)

Summary

Introduction

Up to 50% of infants with congenital heart disease (CHD) have neurodevelopmental impairments later in life [1]. Fetuses with CHD have increased cerebral blood flow [5,6], decreased cerebral vascular resistance [5,6,7,8,9], smaller head circumference [7,8,10], lower total brain weight [11], impairments in sulcation [12,13], altered cerebral metabolism [13,14], and abnormalities on MRI that are in accordance with impaired brain maturation such as ventriculomegaly and increased extra-axial cerebrospinal fluid spaces [15,16]. To assess the association between prenatal Doppler flow patterns, postnatal cerebral oxygenation and short-term neurological outcome

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