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.
Highlights
Congenital heart disease (CHD) is the most common congenital malformation in childhood[1]
When comparing relative regional brain volumes between congenital heart disease (CHD) infants and controls we found the frontal lobe to be smaller in the CHD group preoperatively (ß = −0.18 95% CI −0.32 to −0.04, p = 0.012), whereas the parietal lobe appeared to be larger preoperatively (ß = 0.12, 95% CI 0.01 to 0.23, p = 0.035)
To test the association of regional brain volumes with outcome, were corrected for multiple comparisons, p-values did not remain significant at the < 0.05 threshold (Supplementary Table S5). In this prospective cohort study, we examined the association between perioperative brain volumes and one-year neurodevelopmental outcome in children with severe CHD undergoing cardiopulmonary bypass surgery (CPB) surgery
Summary
Congenital heart disease (CHD) is the most common congenital malformation in childhood[1]. Volumetric analyses of neonatal cerebral MRI examinations have revealed that infants with severe CHD have smaller brain volumes compared to healthy infants[3,8], with all brain regions being affected[3]. While total brain volume reduction has been shown to correlate with neurobehaviour prior to neonatal surgery[4], the impact of neonatal brain volume reduction on neurodevelopmental outcome in early childhood is yet unknown. The aim of our study was to examine neonatal brain volumes in CHD subjects compared to healthy controls and to assess the association of pre- and postoperative total and regional brain volumes with one-year neurodevelopmental outcome in children with severe CHD. Our primary hypothesis is that lower total and regional brain volumes are associated with poorer neurodevelopmental outcome, independent of patient-specific and perioperative risk factors
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