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Prevalence of Cerebral Abnormalities in Children With Congenital Heart Disease: A Systematic Review and Meta-Analysis
Gautam Dagur1,2,3, Cynthia M Ortinau4, Theresa I Chin5
1Health Services Research Center, University Hospitals Research & Education Institute; Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Insights
Structural brain abnormalities are common in fetuses and children with congenital heart disease (CHD), increasing after surgery. This systematic review highlights the prevalence of these conditions across different developmental stages.
Area of Science:
- Neuroscience
- Pediatric Cardiology
- Radiology
Background:
- Congenital heart disease (CHD) poses risks for cerebral abnormalities in children.
- Existing evidence is limited by small sample sizes and single time-point analyses.
Conclusions:
- Structural cerebral abnormalities are highly prevalent in fetuses and children with CHD.
- Postoperative prevalence increases significantly, suggesting potential adverse effects of surgical intervention and care.
Context:
Children with congenital heart disease (CHD) are at risk of cerebral abnormalities. Current evidence is limited by small sample sizes, single-center cohorts, and single time points.
Objective:
Conduct a systematic review and meta-analysis to determine the prevalence of structural cerebral abnormalities on magnetic resonance imaging (MRI) in children with CHD during prenatal, postnatal-preoperative, and postoperative periods.
Data Sources:
Five electronic databases from inception to August 4, 2025.
Study Selection:
Studies published in English in peer-reviewed journals that met the following criteria: 1) samples comprised fetuses from 24 weeks gestation to birth or children from birth to 21 years, with 2) isolated (nonsyndromic) CHD with or without surgical intervention within the first year of life, and 3) reported structural cerebral abnormalities on MRI, during 4) prenatal, postnatal-preoperative, or postoperative period.
Data Extraction:
Data were extracted independently by 2 authors. Data were synthesized using random-effects modeling to determine pooled estimates.
Results:
Overall, 125 studies met the inclusion criteria. Sample size included 521, 1895, and 2443 fetuses and children with CHD for prenatal, postnatal-preoperative, and postoperative analyses, respectively, ensuring sample independence. The pooled overall prevalence of structural cerebral abnormalities was 23.1%, 36.7%, and 50.3% for prenatal, postnatal-preoperative, and postoperative periods, respectively.
Limitations:
Variations in MRI strength, postnatal vs fetal MRI detection capacity, and the underlying rationale for neuroimaging.
Conclusions:
Structural cerebral abnormalities are prevalent in a considerable number of fetuses and children with CHD. A further increase is evident postoperatively, indicating the potential adverse impact of surgical intervention and postoperative care on brain outcomes.
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