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Published on: July 13, 2018
Functional brain maturation and sleep organisation in neonates with congenital heart disease
Tim Hermans1, Liesbeth Thewissen2, Marc Gewillig3
1Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven (University of Leuven), Leuven, Belgium.
Insights
Neonates with congenital heart disease (CHD) show delayed brain maturation and altered sleep patterns, which improve after surgery. These early changes in brain function and sleep are linked to long-term neurodevelopmental outcomes.
Area of Science:
- Neonatal neuroscience
- Pediatric cardiology
- Developmental pediatrics
Background:
- Congenital heart disease (CHD) is associated with structural brain development delays in neonates.
- The impact of CHD on functional brain maturation and sleep-wake physiology remains less understood.
Purpose of the Study:
- To investigate functional brain age (FBA) and sleep organization on EEG in neonates with CHD.
- To assess if these parameters differ in neonates with d-Transposition of the Great Arteries (d-TGA).
- To correlate neonatal findings with neurodevelopmental outcomes at 24 months.
Main Methods:
- Compared multichannel EEG data from 15 neonates with CHD to healthy term newborns.
- Utilized a prediction tool to estimate Functional Brain Age (FBA) from quantitative EEG features.
- Automatically classified neonatal sleep stages and analyzed sleep organization.
- Subgroup analysis for d-Transposition of the Great Arteries (d-TGA).
- Administered the Bayley Scale of Infant Development-III at 24 months for neurodevelopmental assessment.
Main Results:
- Preoperatively, neonates with CHD exhibited delayed FBA, more pronounced in d-TGA infants.
- Significant alterations in sleep organization were observed in CHD neonates, including decreased sleep cycle duration and reduced Active Sleep Stage 1.
- d-TGA infants showed less High Voltage Slow Wave Sleep and more Tracé Alternant compared to controls.
- FBA and sleep organization normalized postoperatively.
- FBA positively correlated with motor scores; High Voltage Slow Wave Sleep duration remained positively correlated with motor scores in d-TGA infants.
Conclusions:
- Neonates with CHD present with altered early brain function and sleep organization.
- Inefficient neonatal sleep is a potential indicator of adverse long-term neurodevelopmental outcomes.
- Further research into mitigating these alterations through clinical interventions like improved cerebral oxygenation, surgery, and nutritional support is warranted.
Objective:
Neonates with Congenital Heart Disease (CHD) have structural delays in brain development. To evaluate whether functional brain maturation and sleep-wake physiology is also disturbed, the Functional Brain Age (FBA) and sleep organisation on EEG during the neonatal period is investigated.
Methods:
We compared 15 neonates with CHD who underwent multichannel EEG with healthy term newborns of the same postmenstrual age, including subgroup analysis for d-Transposition of the Great Arteries (d-TGA) (n = 8). To estimate FBA, a prediction tool using quantitative EEG features as input, was applied. Second, the EEG was automatically classified into the 4 neonatal sleep stages. Neonates with CHD underwent neurodevelopmental testing using the Bayley Scale of Infant Development-III at 24 months.
Results:
Preoperatively, the FBA was delayed in CHD infants and more so in d-TGA infants. The FBA was positively correlated with motor scores. Sleep organisation was significantly altered in neonates with CHD. The duration of the sleep cycle and the proportion of Active Sleep Stage 1 was decreased, again more marked in the d-TGA infants. Neonates with d-TGA spent less time in High Voltage Slow Wave Sleep and more in Tracé Alternant compared to healthy terms. Both FBA and sleep organisation normalised postoperatively. The duration of High Voltage Slow Wave Sleep remained positively correlated with motor scores in d-TGA infants.
Interpretation:
Altered early brain function and sleep is present in neonates with CHD. These results are intruiging, as inefficient neonatal sleep has been linked with adverse long-term outcome. Identifying how these rapid alterations in brain function are mitigated through improvements in cerebral oxygenation, surgery, drugs and nutrition may have relevance for clinical practice and outcome.
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