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J Pediatr. 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.

Author information

1
Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada; Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
2
Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada.
3
Department of Cardiology, Children's National Medical Center, Washington, DC.
4
Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada; School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.
5
Department of Biostatistics and Informatics, Children's National Medical Center, Washington, DC.
6
Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
7
Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
8
Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA.
9
Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada. Electronic address: climpero@childrensnational.org.

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.

PMID:
24367983
PMCID:
PMC4474232
DOI:
10.1016/j.jpeds.2013.11.033
[Indexed for MEDLINE]
Free PMC Article

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