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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal frontal-limbic connectivity is associated with externalizing behaviours in toddlers with Congenital Heart
Alexandra F Bonthrone1, Andrew Chew1, Megan Ní Bhroin2
1Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Insights
Brain network differences in infants with congenital heart disease (CHD) predict later behavioral issues. Specific frontal-limbic network alterations are linked to externalizing behaviors, while early surgery correlates with internalizing behaviors.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Children with Congenital Heart Disease (CHD) face elevated risks for neurodevelopmental impairments.
- The specific neonatal factors influencing behavioral development in these children remain largely unknown.
Purpose of the Study:
- To investigate the relationship between presurgical brain structure and network features in infants with CHD and their later behavioral development.
- To identify early neurobiological and clinical antecedents of internalizing and externalizing problem scores in children with CHD.
Main Methods:
- 43 infants with CHD underwent presurgical diffusion-weighted MRI to construct structural brain networks.
- Behavioral assessments using the Child Behaviour Checklist were conducted at a median age of 22.1 months.
- Analysis included calculation of brain network features, cerebral oxygen delivery, and consideration of perioperative variables, socioeconomic status, and parenting.
Main Results:
- Reduced connectivity and lower degree in the right inferior frontal gyrus and frontal-limbic sub-networks were associated with higher externalizing problem scores.
- Externalizing behaviors were not linked to the neonatal clinical course or home environment.
- Higher internalizing problem scores were associated with earlier neonatal surgery.
Conclusions:
- Frontal-limbic networks are crucial for the development of externalizing behaviors in children with CHD.
- Presurgical brain network characteristics offer insights into early behavioral impairments in this population.
- The timing of neonatal surgery may influence internalizing behaviors in infants with CHD.
Abstract:
Children with Congenital Heart Disease (CHD) are at increased risk of neurodevelopmental impairments. The neonatal antecedents of impaired behavioural development are unknown. 43 infants with CHD underwent presurgical brain diffusion-weighted MRI [postmenstrual age at scan median (IQR) = 39.29 (38.71-39.71) weeks] and a follow-up assessment at median age of 22.1 (IQR 22.0-22.7) months in which parents reported internalizing and externalizing problem scores on the Child Behaviour Checklist. We constructed structural brain networks from diffusion-weighted MRI and calculated edge-wise structural connectivity as well as global and local brain network features. We also calculated presurgical cerebral oxygen delivery, and extracted perioperative variables, socioeconomic status at birth and a measure of cognitively stimulating parenting. Lower degree in the right inferior frontal gyrus (partial ρ = -0.687, p < 0.001) and reduced connectivity in a frontal-limbic sub-network including the right inferior frontal gyrus were associated with higher externalizing problem scores. Externalizing problem scores were unrelated to neonatal clinical course or home environment. However, higher internalizing problem scores were associated with earlier surgery in the neonatal period (partial ρ = -0.538, p = 0.014). Our results highlight the importance of frontal-limbic networks to the development of externalizing behaviours and provide new insights into early antecedents of behavioural impairments in CHD.
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