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Brain injury and development in newborns with critical congenital heart disease
Anastasia Dimitropoulos1, Patrick S McQuillen, Viyeka Sethi
1Department of Pediatrics, University of British Columbia, and Child & Family Research Institute, Vancouver, Canada.
Insights
Brain injuries in newborns with congenital heart disease (CHD) are linked to impaired brain development. Modifiable clinical factors, such as blood pressure, can influence these injuries, particularly before surgery.
Area of Science:
- Neonatal neurology
- Pediatric cardiology
- Neuroimaging
Background:
- Congenital heart disease (CHD) poses significant risks to neonatal brain development.
- Brain injury and altered development are common complications in newborns with CHD.
- Understanding the relationship between brain injury and developmental outcomes is crucial for early intervention.
Purpose of the Study:
- To investigate the association between radiologically identified brain injuries and delayed brain development in term newborns with CHD.
- To assess brain microstructural integrity and metabolic status in relation to brain injury severity.
- To identify clinical risk factors associated with brain injury in this population.
Main Methods:
- Magnetic resonance imaging (MRI) was used to assess brain injury severity (BIS), white matter microstructure (fractional anisotropy [FA] and average diffusivity [Dav]), and brain metabolism (N-acetylaspartate [NAA]/choline [Cho] and lactate/Cho) in 120 preoperative and 104 postoperative newborns.
- Brain development markers included increasing NAA/Cho and FA, and decreasing Dav and lactate/Cho.
Main Results:
- Newly acquired brain injury occurred in 41% preoperatively and 30% postoperatively.
- Lower white matter FA and NAA/Cho were associated with increased preoperative BIS.
- Preoperative BIS predicted higher postoperative Dav and lactate/Cho. New postoperative brain injuries correlated with lower white matter FA and lower postoperative blood pressures.
Conclusions:
- Brain injuries in newborns with CHD are strongly associated with abnormal brain microstructural and metabolic development, particularly preoperatively.
- Both newly acquired preoperative and postoperative brain injuries are linked to potentially modifiable clinical risk factors, highlighting targets for intervention.
Objective:
To determine the relationship between radiologically identifiable brain injuries and delayed brain development as reflected by brain metabolic and microstructural integrity.
Methods:
Term newborns with congenital heart disease (CHD) (120 preoperatively and 104 postoperatively) were studied with MRI to determine brain injury severity (BIS), microstructure reflected by fractional anisotropy (FA) and average diffusivity (Dav), and metabolism reflected by N-acetylaspartate (NAA)/choline (Cho) and lactate/Cho. Brain development is characterized by increasing NAA/Cho and white matter FA, and by decreasing Dav and lactate/Cho.
Results:
Newly acquired brain injury was common (41% preoperative, 30% postoperative). Lower white matter FA (p = 0.005) and lower NAA/Cho (p = 0.01) were associated with increasing preoperative BIS. Higher neonatal illness severity scores (p = 0.03), lower preoperative oxygen saturation (p = 0.002), hypotension (p < 0.001), and septostomy (p = 0.002) were also predictive of higher preoperative BIS. Preoperative FA, Dav, and NAA/Cho did not predict new postoperative BIS. Increasing preoperative BIS predicted higher postoperative Dav (p = 0.002) and lactate/Cho (p = 0.008). Within the postoperative scan, new brain injuries were associated with lower white matter FA (p = 0.04). Postoperative BIS (new lesions) was associated with lower postoperative systolic (p = 0.03) and mean (p = 0.05) blood pressures.
Conclusions:
Brain injuries in newborns with CHD are strongly related to abnormalities of brain microstructural and metabolic brain development, especially preoperatively. Both newly acquired preoperative and postoperative brain injuries are related to potentially modifiable clinical risk factors.
