Postoperative brain volumes are associated with one-year neurodevelopmental outcome in children with severe congenital heart disease

TL;DR

This study shows that in children with severe congenital heart disease, brain volumes before and after surgery are reduced and can predict neurodevelopmental outcomes at one year, highlighting potential biomarkers for impairment.

Contribution

It is the first prospective study linking perioperative brain volumes with one-year neurodevelopmental outcomes in neonates with severe CHD.

Findings

CHD infants have lower brain volumes than controls

Postoperative brain volumes predict cognitive and language outcomes

Brain volume reduction correlates with neurodevelopmental impairment

Abstract

Children with congenital heart disease (CHD) remain at risk for neurodevelopmental impairment despite improved peri- and intraoperative care. Our prospective cohort study aimed to determine the relationship between perioperative brain volumes and neurodevelopmental outcome in neonates with severe CHD. Pre- and postoperative cerebral MRI was acquired in term born neonates with CHD undergoing neonatal cardiopulmonary bypass surgery. Brain volumes were measured using an atlas prior based automated method. One-year outcome was assessed with the Bayley-III. CHD infants (n=77) had lower pre- and postoper-ative total and regional brain volumes compared to controls (n=44, all p<0.01). CHD infants had poorer cognitive and motor outcome (p<=0.0001) and a trend towards lower language composite score compared to controls (p=0.06). The total and selected regional postoperative brain volumes predicted cognitive and language outcome (all p<0.04). This association was independent of length of intensive care unit stay for total, cortical, temporal, frontal and cerebellar volumes. In CHD neonates undergoing cardiopulmonary bypass surgery, pre- and postoperative brain volumes are reduced, and postoperative brain volumes predict cognitive and language outcome at one year. Reduced cerebral volumes in CHD patients could serve as a biomarker for im-paired outcome.