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. 2013 Jul 16;81(3):241-8.
doi: 10.1212/WNL.0b013e31829bfdcf. Epub 2013 Jun 14.

Brain injury and development in newborns with critical congenital heart disease

Anastasia Dimitropoulos  1 , Patrick S McQuillen, Viyeka Sethi, Alisha Moosa, Vann Chau, Duan Xu, Rollin Brant, Anthony Azakie, Andrew Campbell, A James Barkovich, Kenneth J Poskitt, Steven P Miller
Affiliations

Brain injury and development in newborns with critical congenital heart disease

Anastasia Dimitropoulos et al. 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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Figures

Figure
Figure. Association between preoperative brain injury score and average diffusivity before and after bypass surgery
Box plots of average diffusivity before and after bypass surgery are presented by the preoperative brain injury score. This figure illustrates the decrease in average diffusivity (in mm2/sec × 10−6, adjusted for postmenstrual age) between the 2 time points, before and after surgery. Average diffusivity is expected to decrease over time. Note the blunted decrease in average diffusivity in neonates with brain injury, particularly when moderate–severe. MR = magnetic resonance.
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