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Individual Assessment of Perioperative Brain Growth Trajectories in Infants With Congenital Heart Disease:
Daniel Cromb1, Alexandra F Bonthrone1, Alessandra Maggioni1
1Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom.
Insights
Infants with congenital heart disease (CHD) show impaired brain growth around surgery, linked to longer intensive care stays. Brainstem and deep gray matter are particularly vulnerable to clinical factors during this critical period.
Area of Science:
- Neuroscience
- Pediatric Cardiology
- Developmental Biology
Background:
- Congenital heart disease (CHD) poses risks for neurodevelopmental impairments in infants.
- Impaired brain growth may underlie these neurodevelopmental deficits.
- Understanding perioperative brain growth is crucial for managing infants with CHD.
Purpose of the Study:
- To characterize perioperative brain growth trajectories in infants with CHD.
- To assess deviations from normative brain growth.
- To correlate individualized brain growth with clinical risk factors.
Main Methods:
- Magnetic resonance imaging (MRI) was used for preoperative and postoperative brain volume assessment in 36 infants with CHD.
- Normative growth curves were established from 219 healthy infants.
- Z-scores quantified regional brain volume deviations, and changes were correlated with clinical data.
Main Results:
- Overall impaired perioperative brain growth was observed in infants with CHD.
- Impaired growth correlated with longer postoperative intensive care unit (ICU) stays.
- Specific clinical factors like creatinine levels, age at surgery, and cardiopulmonary bypass duration were associated with impaired growth in brainstem and deep gray matter regions.
Conclusions:
- Infants with CHD experience impaired brain growth perioperatively, associated with ICU duration.
- The brainstem is particularly vulnerable to the perioperative clinical course.
- Deep gray matter vulnerability suggests susceptibility to hypoxic injury, impacting neurodevelopmental outcomes.
Abstract:
Background Infants with congenital heart disease (CHD) are at risk of neurodevelopmental impairments, which may be associated with impaired brain growth. We characterized how perioperative brain growth in infants with CHD deviates from typical trajectories and assessed the relationship between individualized perioperative brain growth and clinical risk factors. Methods and Results A total of 36 infants with CHD underwent preoperative and postoperative brain magnetic resonance imaging. Regional brain volumes were extracted. Normative volumetric development curves were generated using data from 219 healthy infants. Z-scores, representing the degree of positive or negative deviation from the normative mean for age and sex, were calculated for regional brain volumes from each infant with CHD before and after surgery. The degree of Z-score change was correlated with clinical risk factors. Perioperative growth was impaired across the brain, and it was associated with longer postoperative intensive care stay (false discovery rate P<0.05). Higher preoperative creatinine levels were associated with impaired brainstem, caudate nuclei, and right thalamus growth (all false discovery rate P=0.033). Older postnatal age at surgery was associated with impaired brainstem and right lentiform growth (both false discovery rate P=0.042). Longer cardiopulmonary bypass duration was associated with impaired brainstem and right caudate growth (false discovery rate P<0.027). Conclusions Infants with CHD can have impaired brain growth in the immediate postoperative period, the degree of which associates with postoperative intensive care duration. Brainstem growth appears particularly vulnerable to perioperative clinical course, whereas impaired deep gray matter growth was associated with multiple clinical risk factors, possibly reflecting vulnerability of these regions to short- and long-term hypoxic injury.
