Atypical Development of Functional Brain Networks in Neonates with Congenital Heart Disease

Congenital heart disease (CHD) affects ∼1% of live births in the United States and is the most prevalent congenital disorder. Despite advances in neonatal cardiovascular surgery improving survival, neurodevelopmental impairments remain prevalent, impacting motor skills, social behavior, and executive function. Motor deficits and long-term challenges in emotional regulation and memory are particularly common. Recent research using resting-state functional MRI (rs-fMRI) has revealed disorganized brain networks in newborns with CHD. However, those few prior rs-fMRI studies examining the impact of CHD have relied on predefined brain parcellations to compare group-level connectivity, limiting the ability to capture spatial alterations in neonatal brain networks in CHD. Understanding these network-level changes is critical for elucidating mechanisms of neurodevelopmental impairment and identifying early biomarkers of risk. To address these gaps, our study introduces two conceptual advances: (1) a data-driven approach to investigate atypical brain network development in high-risk CHD and (2) the use of a population-sized, independent dataset of healthy newborns to derive a normative set of neonatal brain networks. By analyzing a large rs-fMRI of human newborns (N = 448; 219 females and 229 males), we identify atypical brain activity in the sensorimotor and limbic networks of newborns with complex CHD. Notably, before cardiovascular surgery, these networks are split into left and right hemispheric subnetworks. Postoperatively, these components coalesce into a singular, symmetric pattern resembling networks observed in healthy neonates. Our study highlights the potential of rs-fMRI to detect subtle, early functional disruptions in CHD and may inform future biomarkers of neurodevelopmental risk.