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Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome
Patrick T Hangge1, James F Cnota, Jessica G Woo
1Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Poor fetal head growth in hypoplastic left heart syndrome (HLHS) is linked to adverse neurologic outcomes, but not increased mortality. This finding highlights the importance of monitoring head development in HLHS patients.
Area of Science:
- Pediatric Cardiology
- Fetal Development
- Neonatal Neurology
Background:
- Hypoplastic left heart syndrome (HLHS) presents significant mortality and morbidity risks.
- Fetal head growth abnormalities are observed in some HLHS cases, but their impact on outcomes is unclear.
- This study investigates the association between poor fetal head growth and adverse clinical outcomes in HLHS.
Purpose of the Study:
- To determine if poor fetal head growth correlates with adverse clinical outcomes in HLHS patients.
- To analyze the relationship between microcephaly, head size, and head growth patterns and clinical outcomes.
- To assess the impact of these growth patterns on mortality and neurologic outcomes.
Main Methods:
- Retrospective cohort study of HLHS patients from midgestation to 1 year of age.
- Analysis of fetal and birth anthropometric measurements using the Olsen standard.
- Collection and review of clinical outcomes, including mortality and neurologic assessments.
Main Results:
- A high incidence of microcephaly (12%), small head size (27%), and poor head growth (32%) was observed in HLHS neonates.
- All-cause mortality was 31% at 30 days and 43% at 1 year.
- Adverse neurologic outcomes were significantly increased in patients with microcephaly (43% vs. 4%; P = 0.02).
Conclusions:
- Fetal and neonatal microcephaly in term, nonsyndromic HLHS are associated with early adverse neurologic outcomes.
- Microcephaly did not show a significant association with increased mortality in this cohort.
- These findings underscore the importance of monitoring fetal head growth in HLHS for predicting neurologic complications.
Background:
Hypoplastic left heart syndrome (HLHS) is associated with significant mortality and morbidity. Fetal head growth abnormalities have been identified in a subset of HLHS fetuses, but it is unclear whether specific patterns of maladaptive growth affect clinical outcomes. We hypothesized that poor fetal head growth is associated with an increased frequency of adverse clinical outcomes.
Methods:
We retrospectively examined a cohort of HLHS patients from midgestation to 1 y of age. Fetal and birth anthropometric measurements were analyzed using the Olsen standard, and clinical outcomes were obtained.
Results:
A total of 104 HLHS patients were identified over a 12-y period; fetal data were available in 38 cases. HLHS neonates demonstrated a high incidence of microcephaly (12%), small head size (27%), and poor head growth (32%). All-cause mortality was 31% at 30 d and 43% at 1 y. Neurologic outcomes were observed in 12% of patients and were significantly increased with microcephaly (43 vs. 4%; P = 0.02). The average length of hospital stay following stage I palliation was 33.4 ± 33 d, correcting for early death.
Conclusion:
In term nonsyndromic HLHS, fetal and neonatal microcephaly are associated with early adverse neurologic outcomes but not mortality.
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