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Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study.

ABSTRACT: OBJECTIVES:Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury. STUDY DESIGN:Prospective observational study. SETTING:Single centre UK tertiary neonatal intensive care unit. PATIENTS:70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery. MAIN OUTCOME MEASURES:Prevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage. RESULTS:Brain lesions were observed in 39% of subjects (95%?CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not. CONCLUSIONS:Cerebral injury in newborns with CHD prior to surgery is common.

SUBMITTER: Kelly CJ

PROVIDER: S-EPMC6801127 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study.

Kelly Christopher J CJ Arulkumaran Sophie S Tristão Pereira Catarina C Cordero-Grande Lucilio L Hughes Emer J EJ Teixeira Rui Pedro A G RPAG Steinweg Johannes K JK Victor Suresh S Pushparajah Kuberan K Hajnal Joseph V JV Simpson John J Edwards A David AD Rutherford Mary A MA Counsell Serena J SJ

Archives of disease in childhood 20190626 11

<h4>Objectives</h4>Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.<h4>Study design</h4>Prospective observational study.<h4>Setting</h4>Single centre UK tertiary neonatal intensive care unit.<h4>Patients</h4>70 newborn infants with critical or serious CHD underwent brain MRI pri ...[more]

PMID: 31243012

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Project description:A retrospective review of admission preductal oxygen saturations of neonates with antenatally diagnosed critical congenital heart disease (CCHD) was performed to investigate the differences in newborn pulse oximetry (Pulsox) by specific CCHD diagnosis. Saturations were recorded at median of <?1 h (range <?1-9 h) after delivery. Data was stratified by CCHD diagnosis and analysed according to the three different admission Pulsox thresholds, ??90, ??92 and ??95%. Of the 276 neonates studied, 208 were clinically well at admission, with no co-morbidities, gestation >?34 weeks and birth weight >?1.8 kg. A statistically significant increase in the proportion with low admission saturations was seen using ??95% saturation threshold (72% (95% CI 66-78)) compared to ??92% (52% (95% CI 46-59)) and ??90% (46% (95% CI 39-52)). Sub-group analysis found the proportion of neonates with low saturations varied according to the specific CCHD diagnosis with only 20-42% of neonates with aortic stenosis, coarctation of the aorta and pulmonary stenosis having saturations ??95%.The proportion of neonates with low admission oxygen saturation varied by CCHD diagnosis with those without critically reduced pulmonary blood flow not having low admission saturations, in general, even using the ??95% threshold which had the highest proportions of abnormal saturations. This data may assist developing Pulsox screening policies. What is Known: • The addition of pulse oximetry (Pulsox) screening to the routine newborn examination increases the sensitivity of CCHD detection. Pulsox screening is also highly specific for CCHD in asymptomatic neonates, with low false-positive rates. • Early diagnosis of CCHD improves patient outcomes in relation to both morbidity and mortality. What is New: • The proportion of affected infants with an abnormal Pulsox result varies by CCHD diagnosis and screening threshold. In our study using the ??95% threshold gave the highest proportion of neonates with abnormal saturations at admission. • In general, Pulsox yield of abnormal results is low for CCHD diagnoses not associated with critically reduced pulmonary blood flow; however, increasing the Pulsox threshold increased the proportion of infants with an abnormal result.

Project description:BACKGROUND:Given the central role of the thalamus in motor, sensory, and cognitive development, methods to study emerging thalamocortical connectivity in early infancy are of great interest. PURPOSE:To determine the feasibility of performing probabilistic tractography-based thalamic parcellation (PTbTP) in typically developing (TD) neonates and to compare the results with a pilot sample of neonates with congenital heart disease (CHD). STUDY TYPE:Institutional Review Board (IRB)-approved cross-sectional study. MODEL:We prospectively recruited 20 TD neonates and five CHD neonates (imaged preoperatively). FIELD STRENGTH/SEQUENCE:MRI was performed at 3.0T including diffusion-weighted imaging (DWI) and 3D magnetization prepared rapid gradient-echo (MPRAGE). ASSESSMENT:A radiologist and trained research assistants segmented the thalamus and seven cortical targets for each hemisphere. Using the thalami as seeds and the cortical labels as targets, FSL library tools were used to generate probabilistic tracts. A Hierarchical Dirichlet Process algorithm was then used for clustering analysis. A radiologist qualitatively assessed the results of clustering. Quantitative analyses were also performed. STATISTICAL TESTS:We summarized the demographic data and results of clustering with descriptive statistics. Linear regressions covarying for gestational age were used to compare groups. RESULTS:In 17 of 20 TD neonates, we identified five connectivity-determined clusters, which correlate with known thalamic nuclei and subnuclei. In four neonates with CHD we observed a spectrum of abnormalities including fewer and disorganized clusters or small supernumerary clusters (up to seven per thalamus). After covarying for differences in corrected gestational age (cGA), the fractional anisotropy (FA), volume, and normalized thalamic volume were significantly lower in CHD neonates (P < 0.01). DATA CONCLUSIONS:Using PTbTP clusters, correlating well with the location and connectivity of known thalamic nuclei, were identified in TD neonates. Differences in thalamic clustering outputs were identified in four neonates with CHD, raising concern for disordered thalamic connectivity. PTbTP is feasible in TD and CHD neonates. Preliminary findings suggest the prenatal origins of altered connectivity in CHD. LEVEL OF EVIDENCE:2 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:1626-1637.

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Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study.

Publications

Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study.

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