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Brain Injury and Neurodevelopmental Outcome in Congenital Heart Disease: A Systematic Review
Mirthe J Mebius1, Elisabeth M W Kooi2, Catherina M Bilardo3
1Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, Netherlands; and m.j.mebius01@umcg.nl.
Insights
Brain abnormalities before and after surgery in infants with congenital heart disease (CHD) are common and linked to neurodevelopmental issues. Early detection and awareness are crucial for better infant outcomes.
Area of Science:
- Neonatal neurology
- Pediatric cardiology
- Developmental neuroscience
Background:
- Infants with congenital heart disease (CHD) undergoing surgery are at risk for neurodevelopmental impairment due to prenatal and postnatal brain injury.
- A comprehensive review of cerebral findings and their impact on neurodevelopmental outcome (NDO) in this population is lacking.
Purpose of the Study:
- To evaluate the association between prenatal and postnatal preoperative cerebral findings and NDO in infants with CHD requiring surgery.
- To synthesize existing literature on brain injury and neurodevelopmental outcomes in infants with CHD.
Main Methods:
- Systematic literature search of PubMed and Embase (2000-2016) for studies on prenatal cerebral findings, postnatal preoperative cerebral findings, and their association with NDO.
- Independent screening and data extraction by two reviewers, with study quality assessed using the Newcastle-Ottawa Quality Assessment Scale.
Main Results:
- Abnormal cerebral findings are prevalent in infants with CHD during both prenatal and postnatal preoperative periods.
- Common prenatal findings include delayed cerebral development; postnatal findings include white matter injury, periventricular leukomalacia, and stroke.
- Abnormal Doppler measurements, brain immaturity, cerebral oxygenation, and abnormal EEG/aEEG were significantly associated with NDO.
Conclusions:
- Prenatal and postnatal preoperative cerebral abnormalities are significant contributors to neurodevelopmental impairment in infants with CHD.
- Increased awareness among caregivers regarding the vulnerability of the developing brain in infants with CHD is essential.
- Limitations include the observational nature of studies, heterogeneity of CHD types, and varying reference values.
Context:
Brain injury during prenatal and preoperative postnatal life might play a major role in neurodevelopmental impairment in infants with congenital heart disease (CHD) who require corrective or palliative surgery during infancy. A systematic review of cerebral findings during this period in relation to neurodevelopmental outcome (NDO), however, is lacking.
Objective:
To assess the association between prenatal and postnatal preoperative cerebral findings and NDO in infants with CHD who require corrective or palliative surgery during infancy.
Data Sources:
PubMed, Embase, reference lists.
Study Selection:
We conducted 3 different searches for English literature between 2000 and 2016; 1 for prenatal cerebral findings, 1 for postnatal preoperative cerebral findings, and 1 for the association between brain injury and NDO.
Data Extraction:
Two reviewers independently screened sources and extracted data on cerebral findings and neurodevelopmental outcome. Quality of studies was assessed using the Newcastle-Ottawa Quality Assessment Scale.
Results:
Abnormal cerebral findings are common during the prenatal and postnatal preoperative periods. Prenatally, a delay of cerebral development was most common; postnatally, white matter injury, periventricular leukomalacia, and stroke were frequently observed. Abnormal Doppler measurements, brain immaturity, cerebral oxygenation, and abnormal EEG or amplitude-integrated EEG were all associated with NDO.
Limitations:
Observational studies, different types of CHD with different pathophysiological effects, and different reference values.
Conclusions:
Prenatal and postnatal preoperative abnormal cerebral findings might play an important role in neurodevelopmental impairment in infants with CHD. Increased awareness of the vulnerability of the young developing brain of an infant with CHD among caregivers is essential.
