Related Experiment Video
Updated: Jul 10, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease:
Astrid Neukomm1, Nathalie H P Claessens2, Alexandra F Bonthrone3
1Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Preoperative white matter lesions in infants with severe congenital heart disease (CHD) predict poorer gross motor skills. Socioeconomic status and hospital stay also impact neurodevelopmental outcomes in early childhood.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Pediatric Neurology
Background:
- Severe congenital heart disease (CHD) affects neurodevelopment.
- Perioperative brain injury is a concern in infants undergoing cardiac surgery.
- Early childhood neurodevelopmental outcomes require further investigation in this population.
Purpose of the Study:
- To investigate the association between perioperative brain injury and neurodevelopmental outcomes in early childhood for infants with severe CHD.
- To identify specific MRI markers of brain injury predictive of motor and cognitive development.
- To explore the influence of clinical factors like length of hospital stay and socioeconomic status on outcomes.
Main Methods:
- 170 infants with severe CHD underwent preoperative and postoperative brain MRI.
- Brain injury was quantified using a standardized scoring system.
- Motor and cognitive functions were assessed using the Bayley Scales of Infant and Toddler Development Third Edition.
- Multiple linear regression analysis adjusted for clinical confounders.
Main Results:
- No overall brain injury score correlated with motor or cognitive outcomes.
- Preoperative white matter lesions significantly predicted gross motor outcome (P=.013).
- Socioeconomic status (P<.001) and length of hospital stay (P<.001) were independently associated with cognitive and motor outcomes, respectively.
Conclusions:
- Preoperative white matter lesions are a key MRI predictor of adverse gross motor outcomes in infants with severe CHD.
- Length of hospital stay and socioeconomic status are significant factors influencing neurodevelopmental trajectories.
- Future interventions should consider these risk factors for improved outcomes.
Objective:
To examine the relationship between perioperative brain injury and neurodevelopment during early childhood in patients with severe congenital heart disease (CHD).
Study Design:
One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up.
Results:
Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = -0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = -0.35).
Conclusion:
Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.
