# The “Heart-and-Brain Interaction” in Newborns with Complex Congenital Heart Disease

## TL;DR

Newborns with complex heart defects show brain abnormalities and delayed brain development, which could increase their surgical risks and affect future brain function.

## Contribution

This study identifies distinct patterns of brain volume loss and immaturity in newborns with complex CHD before surgery.

## Key findings

- 69% of CHD neonates showed brain immaturity relative to gestational age.
- Cerebral MRI was abnormal in 57% of patients, with multiple types of brain lesions observed.
- CHD neonates had reduced brain volumes and increased cerebrospinal fluid volumes compared to controls.

## Abstract

Neonates with complex congenital heart disease (CHD), in particular newborns with hypoplastic left heart syndrome (HLHS) or transposition of the great arteries (TGA), may show brain pathologies and altered brain growth after birth. Our prospective study investigates brain volumes and immature brain structures in these patient groups compared to healthy controls.

Neonatal cerebral magnetic resonance imaging (MRI) scans were analysed by semi-automated segmentation (dHCP pipeline) in 51 children: 31 HLHS/hypoplastic left heart complex (HLHC)/UVH (61%) at stage I, in 18 neonates with TGA (35%) and in 2 with aortic arch obstruction and biventricular physiology (4%) at a mean GA 41.2 weeks, and in 209 controls at a mean GA 41.6 at time of the MRI. Newborns born premature were excluded. Brain volume comparisons used mixed models for imaging techniques and linear regression for CHD-control differences.

Cerebral MRI was abnormal in 29 patients (57%), with multiple lesions in some patients: including liquor space enlargements (20%), small grey (20%) and white matter injuries (12%), stroke (8%), subdural haemorrhage (22%), and sinus venous thrombosis (8%). Sixty-nine percent of CHD neonates showed signs of brain immaturity in relation to GA. Intracranial volumes were reduced, while cerebrospinal fluid (CSF) volumes were enlarged compared to controls.

Neonates with complex CHD show reduced cerebral growth, higher risk for brain injuries, and impaired brain maturation, even before first surgery. This might constitute a higher perioperative risk in these patient groups than for normal developed brains. Identification of distinct patterns of brain volume loss might enable risk stratification for subsequent neuro-developmental impairment.

DRKS00036700.

Children with congenital heart disease (CHD) present with increased risk for neuro-developmental impairments.