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Updated: Oct 21, 2025
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Serial neurosonography in fetuses with congenital heart defects shows mild delays in cortical development
Sheila M Everwijn1, Jiska F van Bohemen2, Nan van Geloven3
1Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Congenital heart defects (CHD) in fetuses show minor differences in specific brain cortical areas. These subtle changes in fetal brain development may impact neurodevelopmental outcomes, though clinical significance is currently unknown.
Area of Science:
- Neuroscience
- Fetal Medicine
- Pediatric Cardiology
Background:
- Neurodevelopmental delay is frequently observed in infants with congenital heart defects (CHD).
- Prenatal neurological impairment due to cardiac defects is hypothesized to cause delayed cortical development in fetuses with CHD.
- This study investigates early signs of neurological differences in fetuses diagnosed with CHD.
Purpose of the Study:
- To assess cerebral cortical maturation in fetuses with CHD.
- To compare fetal brain development in CHD cases versus controls.
- To identify potential early indicators of neurodevelopmental differences in utero.
Main Methods:
- Advanced neurosonographic examinations were performed every 4 weeks in fetuses with CHD and controls.
- Blinded examiners used a standardized cortical maturation scheme to score five primary fissures and four areas (0-5 scale).
- A total of 574 ultrasound examinations were analyzed (85 CHD fetuses, 61 controls).
Main Results:
- Minor differences in cortical maturation scores were observed in the Sylvian and cingulate fissures of fetuses with CHD compared to controls.
- Specifically, the Sylvian fissure showed a -0.12 grade difference (p=0.05) and the cingulate fissure showed a -0.24 grade difference (p<0.001).
- Maturation in other analyzed cortical areas did not significantly differ between CHD fetuses and controls.
Conclusions:
- This study found subtle differences in three of nine cortical areas in fetuses with CHD, contrasting with prior reports of significant third-trimester delay.
- The clinical relevance of these minor observed differences in fetal brain development remains undetermined.
- Further research is needed to understand the long-term neurodevelopmental implications for infants with CHD.
Introduction:
Neurodevelopmental delay is more common in children born with congenital heart defects (CHD), even with optimal perinatal and peri-operative care. It is hypothesized that fetuses with CHD are prone to neurological impairment in utero due to their cardiac defect, possibly leading to delayed cortical development.
Methods:
Cerebral cortical maturation was assessed with advanced neurosonographic examinations every 4 weeks in fetuses with CHD and compared to control fetuses. Five different primary fissures and four areas were scored (ranging 0-5) by blinded examiners using a cortical maturation scheme.
Results:
Cortical staging was assessed in 574 ultrasound examinations in 85 CHD fetuses and 61 controls. Small differences in grading were seen in Sylvian and cingulate fissures. (Sylvian fissure: -0.12 grade, 95% CI (-0.23; -0.01) p = 0.05, cingulate fissure: -0.24 grade, 95% CI (-0.38; -0.10) p = <0.001. Other cortical areas showed normal maturation as compared to control fetuses.
Conclusion:
Small differences were seen in three of the nine analyzed cortical areas in CHD fetuses, in contrast to previous reports on progressive third-trimester delay. The clinical implications of the small differences however, remain unknown.
