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Abnormal brain structure and function in newborns with complex congenital heart defects before open heart surgery: a
Mallory Owen1, Michael Shevell, Annette Majnemer
1McGill University, Neurology and Neurosurgery, Montreal, Quebec, Canada.
Insights
Newborns with complex congenital heart defects often have neurological issues before surgery. Early detection and intervention are crucial for their neurodevelopmental outcomes.
Area of Science:
- Pediatric Neurology
- Neonatal Cardiology
- Developmental Neuroscience
Background:
- Complex congenital heart defects (CCHDs) pose significant risks for neurological abnormalities in newborns.
- Understanding the timing and extent of these abnormalities is vital for neurodevelopmental assessment and early intervention strategies.
Purpose of the Study:
- To review and synthesize recent literature on neurological and neurobehavioral abnormalities in fetuses and newborns with CCHDs prior to cardiac surgery.
- To highlight the implications of these findings for early screening and intervention.
Main Methods:
- Systematic literature review of studies focusing on neurological and neurobehavioral assessments in fetuses and newborns with CCHDs before surgical correction.
- Analysis of findings from conventional and advanced neuroimaging, electrophysiology, and neurobehavioral evaluations.
Main Results:
- A significant proportion of newborns with CCHDs exhibit preoperative neurobehavioral and electrophysiological abnormalities.
- Conventional neuroimaging reveals brain injury in a high percentage of these infants.
- Advanced imaging shows delayed fetal brain growth and impaired neonatal white matter maturation, with altered metabolite levels (e.g., reduced N-acetylaspartate, increased lactate).
Conclusions:
- Neurological impairments in newborns with CCHDs appear to originate in the fetal or early postnatal period.
- There is a critical need for developing and implementing reliable methods for early screening and developmental interventions for this high-risk population.
Abstract:
Newborns with complex congenital heart defects are at high risk for developing neurological abnormalities. It is important to understand the timing, progression, and extent of these abnormalities to better elucidate their potential impact on neurodevelopment, and their implications for early screening and intervention. This review synthesizes the recent literature describing neurological and neurobehavioral abnormalities observed in fetuses and newborns before cardiac surgery. A considerable proportion of newborns with complex congenital heart defects exhibit neurobehavioral and electrophysiological abnormalities preoperatively. Likewise, conventional neuroimaging studies reported that a high percentage of this population experienced brain injury. Advanced neuroimaging modalities indicated that fetuses showed delayed third trimester brain growth, and newborns showed impaired white matter maturation, reduced N-acetylaspartate, and increased lactate. These findings suggest a fetal or early postnatal onset of impaired brain growth and development. Consequently, reliable methods for early screening and subsequent developmental intervention must be implemented.
