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Journal of Pediatrics, The

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Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease: Results from a European Collaboration - 20/02/24

Doi : 10.1016/j.jpeds.2023.113838 
Astrid Neukomm, MD 1, †, Nathalie H.P. Claessens, MD, PhD 2, 3, 4, 5, 6, †, Alexandra F. Bonthrone, PhD 7, Raymond Stegeman, MD, PhD 8, Maria Feldmann, MD, PhD 1, Maaike Nijman, MD 2, 3, 4, 5, 6, Nicolaas J.G. Jansen, MD, PhD 3, 8, Joppe Nijman, MD, PhD 3, Floris Groenendaal, MD, PhD 2, 6, Linda S. de Vries, MD, PhD 2, 6, Manon J.N.L. Benders, MD, PhD 2, 6, Johannes M.P.J. Breur, MD, PhD 4, Felix Haas, MD, PhD 5, Mireille N. Bekker, MD, PhD 9, Thushiha Logeswaran, MD, PhD 10, Bettina Reich, MD, PhD 11, Raimund Kottke, MD 12, Hitendu Dave, MD 13, John Simpson, FRCP, MD 14, Kuberan Pushparajah, MRCPCH, MD 7, 14, Christopher J. Kelly, MRCPCH, PhD 7, Sophie Arulkumaran, FRCR, PhD 7, Mary A. Rutherford, FRCR, FRCPCH, MD 7, Serena J. Counsell, PhD 7, Andrew Chew, MD 7, Walter Knirsch, MD 15, Maaike C.A. Sprong, PT, MSc 16, Monique M. van Schooneveld, PhD 17, Cornelia Hagmann, MD, PhD 18, †, Beatrice Latal, MD, MPH 1, †
for the

European Association Brain in Congenital Heart Disease (EU-ABC) consortium

1 Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland 
2 Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands 
3 Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands 
4 Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands 
5 Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands 
6 Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands 
7 Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom 
8 Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands 
9 Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands 
10 Pediatric Heart Center, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany 
11 Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany 
12 Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland 
13 Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland 
14 Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom 
15 Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland 
16 Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands 
17 Department of Pediatric Psychology, Neuropsychology Section, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands 
18 Department of Neonatology and Pediatric Intensive Care, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland 

Abstract

Objective

To examine the relationship between perioperative brain injury and neurodevelopment during early childhood in patients with severe congenital heart disease (CHD).

Study design

One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up.

Results

Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = −0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = −0.35).

Conclusion

Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.

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Keywords : infant, brain damage, MRI, motor delay, cognitive delay, outcome, congenital heart defect

Abbreviations : Bayley-III, BIS, CHD, (EU-ABC) consortium, KCL, MRI, LOS, LVOTO, SES, SVP, TGA, UCZ, WKZ, WMI, WM


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© 2023  The Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 266

Article 113838- mars 2024 Retour au numéro
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