Brain microstructural development in neonates with critical congenital heart disease: An atlas-based diffusion tensor...

Area of Science:

• Neuroscience
• Developmental Biology
• Pediatric Cardiology

Background:

• Brain microstructural maturation is rapid in late gestation and early infancy.
• Critical congenital heart disease (CHD) can influence typical brain development patterns.

Purpose of the Study:

• To investigate white matter (WM) microstructural development patterns in neonates with critical CHD.
• To assess the association between WM maturity and neonatal ischemic brain injury.

Main Methods:

• Prospective, longitudinal cohort study of 74 neonates undergoing cardiac surgery.
• Diffusion tensor imaging (DTI) used to assess WM microstructure (FA and MD) before and after surgery.
• Analysis included 16 WM structures across three regions, corrected for postmenstrual age.

Main Results:

• WM development followed a posterior-to-anterior and central-to-peripheral pattern, consistent with healthy neonates.
• Neonates with Transposition of the Great Arteries (TGA) and Left Ventricular Outflow Tract Obstruction (LVOTO) showed more mature WM microstructure pre-surgery compared to Single Ventricle Physiology with Aortic Arch Obstruction (SVP-AO).
• No association was found between WM microstructural immaturity and neonatal ischemic brain injury.

Conclusions:

• Brain microstructural development in critical CHD follows established posterior-to-anterior and central-to-peripheral patterns.
• WM maturation varies among different critical CHD types, with TGA and LVOTO exhibiting more mature microstructure pre-operatively.
• WM immaturity in neonates with critical CHD is not linked to ischemic brain injury.