Risk factors for preoperative periventricular leukomalacia in term neonates with hypoplastic left heart syndrome are patient related
Open accessAbstract
Background Preoperative brain injury is common in neonates with complex congenital heart disease. Increasing evidence suggests a complex interaction of prenatal and postnatal risk factors for development of brain white matter injury, called periventricular leukomalacia (PVL), in neonates with complex congenital heart disease. To date, there remains a limited understanding of the risk factors contributing to preoperative PVL in hypoplastic left heart syndrome (HLHS).Methods Neonates with HLHS or HLHS variants from 3 prospective magnetic resonance imaging studies (2003-2010) were selected for this cohort. Preoperative brain magnetic resonance imaging was performed the morning of the surgery. Stepwise multilogistic regression of patient characteristics, mode of delivery (cesarean section vs vaginal), time of diagnosis (prenatal vs postnatal), HLHS subtypes, brain total maturation score, time to surgery, individual averaged daily preoperative blood gases, and complete blood cell count values was used to determine significant associations.Results A total of 57 neonates with HLHS were born at 38.7 ± 2.3 weeks; 86% (49/57) had a prenatal diagnosis, with 31% (18/57) delivered by cesarean section. HLHS with aortic atresia (AA) was common in this cohort, 71% (41/57). Preoperative PVL was identified in 19% (11/57). Male patients with AA (P = .004) were at higher risk for PVL. Lower total brain maturation score was also identified as a strong predictor for preoperative PVL (P = .005).Conclusions In neonates with HLHS, nonmodifiable patient-related factors, including male sex with AA (lack of antegrade blood flow) and lower total brain maturation score, placed neonates at the greatest risk for preoperative white matter injury.
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Tsang, R., Licht, D. J., & Brady, K. M. (2018) · Elsevier eBooks · doi:10.1016/b978-1-4557-0760-7.00017-6
Self-citationCommentary: Predicting Neurodevelopmental Outcome: Magnetic Resonance Imaging vs A Tape Measure
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- Authors
- Goff, D. A., Shera, D. M., Tang, S., Lavin, N. A., Durning, S. M., Nicolson, S. C., Montenegro, L. M., Rome, J. J., Gaynor, J. W., Spray, T. L., Vossough, A., & Licht, D. J.
- Affiliations
- Loma Linda University Medical Center (US)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Children's Hospital of Philadelphia (US)
- Corresponding author
- Goff, Donna A.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 147
- Issue
- 4
- Pages
- 1312-1318
- ISSN
- 0022-5223 (ISSN-L)
- PMC
- PMC3896504
- OpenAlex
- W2138067057
- Cited by
- 65
- References
- 26
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 1 · 2023: 7 · 2022: 6 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 6 · 2017: 5 · 2016: 5 · 2015: 6 · 2014: 5
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Dana Foundation
- National Institute of Neurological Disorders and Stroke (NS052380, NS072338)
- National Heart, Lung, and Blood Institute (T-32 HL-0791543)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
- Keywords
- periventricular leukomalacia, hypoplastic left heart syndrome, term infants, white matter injury, aortic atresia, patient risk factors, sex differences, congenital heart disease, prenatal diagnosis, cesarean section
- MeSH terms
- Female, Humans, Infant, Newborn, Leukomalacia, Periventricular, Male, Prospective Studies, Risk Factors, Hypoplastic Left Heart Syndrome, Preoperative Period
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