Cited by 236Congenital Heart Disease StudiesNeonatal and fetal brain pathologyFetal and Pediatric Neurological Disorders

Brain injury and development in newborns with critical congenital heart disease

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Dimitropoulos, Anastasia, McQuillen, Patrick S., Sethi, Viyeka, Moosa, Alisha, Chau, Vann, Xu, Duan, Brant, Rollin, Azakie, Anthony +4 more·2013·Neurology

Abstract

OBJECTIVE: To determine the relationship between radiologically identifiable brain injuries and delayed brain development as reflected by brain metabolic and microstructural integrity. METHODS: Term newborns with congenital heart disease (CHD) (120 preoperatively and 104 postoperatively) were studied with MRI to determine brain injury severity (BIS), microstructure reflected by fractional anisotropy (FA) and average diffusivity (Dav), and metabolism reflected by N-acetylaspartate (NAA)/choline (Cho) and lactate/Cho. Brain development is characterized by increasing NAA/Cho and white matter FA, and by decreasing Dav and lactate/Cho. RESULTS: Newly acquired brain injury was common (41% preoperative, 30% postoperative). Lower white matter FA (p = 0.005) and lower NAA/Cho (p = 0.01) were associated with increasing preoperative BIS. Higher neonatal illness severity scores (p = 0.03), lower preoperative oxygen saturation (p = 0.002), hypotension (p < 0.001), and septostomy (p = 0.002) were also predictive of higher preoperative BIS. Preoperative FA, Dav, and NAA/Cho did not predict new postoperative BIS. Increasing preoperative BIS predicted higher postoperative Dav (p = 0.002) and lactate/Cho (p = 0.008). Within the postoperative scan, new brain injuries were associated with lower white matter FA (p = 0.04). Postoperative BIS (new lesions) was associated with lower postoperative systolic (p = 0.03) and mean (p = 0.05) blood pressures. CONCLUSIONS: Brain injuries in newborns with CHD are strongly related to abnormalities of brain microstructural and metabolic brain development, especially preoperatively. Both newly acquired preoperative and postoperative brain injuries are related to potentially modifiable clinical risk factors.

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  1. Galli KK, Zimmerman RA, Jarvik GP, et al. Periventric- ular leukomalacia is common after neonatal cardiac sur- gery. J Thorac Cardiovasc Surg 2004;127:692-704.

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Authors
Dimitropoulos, A., McQuillen, P. S., Sethi, V., Moosa, A., Chau, V., Xu, D., Brant, R., Azakie, A., Campbell, A., Barkovich, A. J., Poskitt, K. J., & Miller, S. P.
Affiliations
University of British Columbia (CA)
Venue
Neurology
Published
2013-07-16
Volume
81
Issue
3
Pages
241-248
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
OpenAlex
W1996831127
Cited by
236
References
39
Citations by year
2026: 16 · 2025: 13 · 2024: 10 · 2023: 22 · 2022: 26 · 2021: 21 · 2020: 22 · 2019: 28 · 2018: 22 · 2017: 15 · 2016: 12 · 2015: 17 · 2014: 10 · 2013: 2
FWCI
9.96
Type
journal article
Language
en
Open access
Locations
  • Neurology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Canadian Institutes of Health Research (MOP93780)
  • National Institute of Neurological Disorders and Stroke (R01NS063876, R01NS40117, P50-NS35902, R01NS040117, P50NS035902)
  • National Center for Research Resources (M01RR001271, 5M01RR-01271)
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
congenital heart disease, neonatal brain injury, brain development, white matter microstructure, fractional anisotropy, N-acetylaspartate, lactate, brain metabolism, hypoxia, hypotension, septostomy, neonatal surgery, risk factors
MeSH terms
Brain Injuries, Female, Heart Defects, Congenital, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Nerve Fibers, Myelinated, Risk Factors, Anisotropy

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