Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease
| Autor: | Anne Synnes, Duan Xu, Kenneth J. Poskitt, A. James Barkovich, Steven P. Miller, Ting Guo, Shabnam Peyvandi, Hannah C. Glass, Vann Chau, Patrick S. McQuillen |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Heart disease Transposition of Great Vessels Cardiorespiratory Medicine and Haematology 030204 cardiovascular system & hematology Cardiovascular Bayley Scales of Infant Development neurodevelopmental outcomes Postoperative Complications 0302 clinical medicine Longitudinal Studies Prospective Studies Critical congenital heart disease Child Stroke Pediatric education.field_of_study medicine.diagnostic_test Brain Magnetic Resonance Imaging congenital heart disease Heart Disease Great arteries Public Health and Health Services Cardiology Biomedical Imaging Injury Severity Score Female Patient Safety Cardiology and Cardiovascular Medicine Heart Defects Congenital medicine.medical_specialty Population Neuroimaging Article Perioperative Care 03 medical and health sciences Clinical Research 030225 pediatrics Internal medicine medicine Humans Cardiac Surgical Procedures education business.industry Neurosciences Infant Newborn Infant Magnetic resonance imaging Perinatal Period - Conditions Originating in Perinatal Period Newborn brain injury medicine.disease Brain Disorders Cardiovascular System & Hematology Neurodevelopmental Disorders Brain Injuries business |
| Zdroj: | Journal of the American College of Cardiology, vol 71, iss 18 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2018.02.068 |
| Popis: | BACKGROUND:Brain injury (BI) is reported in 60% of newborns with critical congenital heart disease as white matter injury (WMI) or stroke. Neurodevelopmental (ND) impairments are reported in these patients. The relationship between neonatal BI and ND outcome has not been established. OBJECTIVES:This study sought to determine the association between peri-operative BI and ND outcomes in infants with single ventricle physiology (SVP) and d-transposition of the great arteries (d-TGA). METHODS:Term newborns with d-TGA and SVP had pre-operative and post-operative brain magnetic resonance imaging and ND outcomes assessed at 12 and 30months with the Bayley Scales of Infant Development-II. BI was categorized by the brain injury severity score and WMI was quantified by volumetric analysis. RESULTS:A total of 104 infants had follow-up at 12months and 70 had follow-up at 30months. At 12months, only clinical variables were associated with ND outcome. At 30months, subjects with moderate-to-severe WMI had significantly lower Psychomotor Development Index (PDI) scores (13 points lower) as compared with those with none or minimal WMI for d-TGA and SVP (p=0.03 and p=0.05, respectively) after adjusting for various factors. Quantitative WMI volume was likewise associated. Stroke was not associated with outcome. The Bland-Altman limits of agreement for PDI scores at 12 and 30months were wide (-40.3 to 31.2) across the range of mean PDI values. CONCLUSIONS:Increasing burden of WMI is associated with worse motor outcomes at 30months for infants with criticalcongenital heart disease, whereas no adverse association was seen between small strokes and outcome. Theseresults support the utility of neonatal brain magnetic resonance imaging in this population to aid in predictinglateroutcomes and the importance of ND follow-up beyond 1 year of age. |
| Databáze: | OpenAIRE |
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