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Updated: Oct 25, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal brain network integration trajectories predict neurodevelopment in congenital heart disease
Lauren Harasymiw1, Amy Kuang2, Duan Xu2
1Department of Pediatrics; University of California San Francisco, San Francisco, CA, USA. Lauren.Harasymiw@ucsf.edu.
Background:
Infants with critical congenital heart disease (CHD) are at high risk for abnormal brain development and later neurodevelopmental impairment. We hypothesized that the trajectory of perioperative whole-brain network development would predict neurodevelopmental outcomes in early childhood.
Methods:
This prospective longitudinal cohort of neonates with critical CHD (n = 97) underwent preoperative and/or postoperative brain MRI with diffusion imaging. Whole-brain network measures were derived from structural connectomes from 80 infants, and 50 had neurodevelopment assessed at 1-4 years using the Bayley Scales of Infant and Toddler Development.
Results:
White matter injury was associated with a slower perioperative increase in global efficiency (p = 0.013), a measure of network integration, whereas cardiac physiology was not associated with network development. Infants with greater perioperative increases in global efficiency had higher cognitive (p = 0.001), language (p < 0.001), and motor (p = 0.008) scores. For each 1-standard deviation increase in the trajectory of global efficiency, cognitive scores increased by 8.2 points (95% CI: 3.64-12.78), independent of brain injury and socioeconomic factors.
Conclusion:
In infants with critical CHD, longitudinal whole-brain network development was associated with neurodevelopment across multiple domains. Early network development may serve as a biomarker of neurodevelopmental risk and resilience in this population.
Impact:
In infants with critical congenital heart disease, perioperative increase in whole-brain network integration was associated with cognitive, language, and motor outcomes in early childhood. White matter injury was associated with a slower increase in network integration, whereas cardiac physiology subtype was not associated with network development. This study extends prior work by showing that a longitudinal measure of neonatal whole-brain network development, rather than a single imaging timepoint, predicts neurodevelopment across multiple domains. These findings identify early network development as a potential biomarker of neurodevelopmental risk and resilience, and support future risk-stratification and intervention studies in this population.
