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Dev Med Child Neurol. 2018 Oct;60(10):1052-1058. doi: 10.1111/dmcn.13747. Epub 2018 Mar 24.

Perioperative neonatal brain injury is associated with worse school-age neurodevelopment in children with critical congenital heart disease.

Author information

1
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
2
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
3
Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
4
Brain Centre Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
5
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
6
Department of Medical Psychology and Social Work, University Medical Center Utrecht, Utrecht, the Netherlands.
7
Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
8
Child Development and Exercise Center, University Medical Centre Utrecht, Utrecht, the Netherlands.

Abstract

AIM:

To assess the impact of perioperative neonatal brain injury and brain volumes on neurodevelopment throughout school-age children with critical congenital heart disease (CHD).

METHOD:

Thirty-four survivors of neonatal cardiac surgery (seven females, 27 males) were included. Neonatal preoperative and postoperative cerebral magnetic resonance imaging was performed and neurodevelopment was assessed at 24 months (SD 0.7, n=32, using Bayley Score of Infant and Toddler Development, Child Behavior Checklist) and 6 years (mean age 5y 11mo; SD 0.3, n=30, using Movement Assessment Battery for Children, Wechsler Preschool and Primary Scale of Intelligence, Child Behavior Checklist, Teacher Report Form). Brain injury, brain volumes, and cortical measures were related to outcome with adjustment for maternal educational level.

RESULTS:

Two-year cognitive score and 6-year Full-scale IQ were poorer in children with neonatal white matter injury (n=21, all p<0.05), with higher teacher-reported attention problems (p=0.03). Five of six children with involvement of the posterior limb of the internal capsule showed motor problems (p=0.03). Children with a below-average Fulll-scale IQ (<85, n=9) showed smaller volumes of basal ganglia thalami (-8%, p=0.03) and brain stem (-7%, p=0.03).

INTERPRETATION:

Our findings provide evidence of unfavourable outcome in school-age children with critical CHD who acquire perioperative neonatal brain injury.

WHAT THIS PAPER ADDS:

This paper extends knowledge about neonatal brain injury and long-term outcome in congenital heart disease. Children with white matter injury show lower IQ and more attention problems at school age. Injury of the posterior limb of the internal capsule increases the risk of motor problems. This study provides evidence for worse outcomes in neonates acquiring brain injury around cardiac surgery.

PMID:
29572821
DOI:
10.1111/dmcn.13747
[Indexed for MEDLINE]

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