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. 2014 May;164(5):1121-1127.e1.
doi: 10.1016/j.jpeds.2013.11.033. Epub 2013 Dec 22.

Brain volume and neurobehavior in newborns with complex congenital heart defects

Mallory Owen  1 , Michael Shevell  2 , Mary Donofrio  3 , Annette Majnemer  4 , Robert McCarter  5 , Gilbert Vezina  6 , Marine Bouyssi-Kobar  7 , Iordanis Evangelou  7 , Dena Freeman  7 , Neil Weisenfeld  8 , Catherine Limperopoulos  9
Affiliations

Brain volume and neurobehavior in newborns with complex congenital heart defects

Mallory Owen et al. J Pediatr. 2014 May.

Abstract

Objective: To investigate the relationship between tissue-specific alterations in brain volume and neurobehavioral status in newborns with complex congenital heart defects preoperatively.

Study design: Three-dimensional volumetric magnetic resonance imaging was used to calculate tissue-specific brain volumes and a standardized neurobehavioral assessment was performed to assess neurobehavioral status in 35 full-term newborns admitted to the hospital before cardiopulmonary bypass surgery. Multiple linear regression models were performed to evaluate relationships between neurobehavioral status and brain volumes.

Results: Reduced subcortical gray matter (SCGM) volume and increased cerebrospinal fluid (CSF) volume were associated with poor behavioral state regulation (SCGM, P = .04; CSF, P = .007) and poor visual orienting (CSF, P = .003). In cyanotic newborns, reduced SCGM was associated with higher overall abnormal scores on the assessment (P = .001) and poor behavioral state regulation (P = .04), and increased CSF volume was associated with poor behavioral state regulation (P = .02), and poor visual orienting (P = .02). Conversely, acyanotic newborns showed associations between reduced cerebellar volume and poor behavioral state regulation (P = .03).

Conclusion: Abnormal neurobehavior is associated with impaired volumetric brain growth before open heart surgery in infants with complex congenital heart defects. This study highlights a need for routine preoperative screening and early intervention to improve neurodevelopmental outcomes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Input and output for the automatic segmentation of brain tissue volumes. A, Axial T1 slice at the level of the thalami and B, cerebellum; C, axial T2 slice at the level of the thalami and D, cerebellum; E, automatic segmentation of brain tissue volumes at the level of the thalami and F, cerebellum. The tissue classes depicted are CGM (green), unmyelinated white matter (light blue), mWM (dark blue), SCGM (magenta), CSF (red), and cerebellum (yellow).
Figure 2
Figure 2
Relationships between CSF volume and predominant behavioral state (left) and between CSF volume and visual orienting score (right) for all newborns. Higher visual orienting score indicates better performance.
Figure 3
Figure 3
Relationship between SCGM volume and ENNAS scores in newborns with cyanotic (left) and acyanotic CHD (right). Higher ENNAS score indicates greater number of abnormal assessment items.
Figure 4
Figure 4
Relationship between cerebellar volume and predominant behavioral state in newborns with cyanotic (left) and acyanotic CHD (right).
See this image and copyright information in PMC

Comment in

References

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