Antenatal diagnosis, neonatal brain volumes, and neurodevelopment in transposition of the great arteries

Thiviya Selvanathan; Connor Mabbott; Stephanie H Au-Young; Mike Seed; Steven P Miller; Vann Chau; PCNR Study Group

doi:10.1111/dmcn.15840

Antenatal diagnosis, neonatal brain volumes, and neurodevelopment in transposition of the great arteries

Dev Med Child Neurol. 2024 Jan 11. doi: 10.1111/dmcn.15840. Online ahead of print.

Authors

Thiviya Selvanathan^{1

2}, Connor Mabbott³, Stephanie H Au-Young^{1

3}, Mike Seed^{1

4}, Steven P Miller^#^{1

2

3}, Vann Chau^#^{1

3}; PCNR Study Group

Collaborators

PCNR Study Group:
Amandeep Saini, Ingrid Blydt-Hansen, Steven Ufkes, Davide Marini, Ting Guo, Vanna Kazazian, Robert Greer, Mjaye L Mazwi, Pradeep Krishnan, Linh G Ly, Michael-Alice Moga

Affiliations

¹ Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
² Department of Pediatrics, BC Children's Hospital Research Institute and the University of British Columbia, Vancouver, BC, Canada.
³ Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
⁴ Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada.

^# Contributed equally.

PMID: 38204357
DOI: 10.1111/dmcn.15840

Abstract

Aim: To examine whether antenatal diagnosis modifies relationships between neonatal brain volumes and 18-month neurodevelopmental outcomes in children with transposition of the great arteries (TGA).

Method: In a retrospective cohort of 139 children with TGA (77 antenatally diagnosed), we obtained total brain volumes (TBVs) on pre- (n = 102) and postoperative (n = 112) magnetic resonance imaging. Eighteen-month neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Generalized estimating equations with interaction terms were used to determine whether antenatal diagnosis modified associations between TBVs and neurodevelopmental outcomes accounting for postmenstrual age at scan, brain injury, and ventricular septal defect.

Results: Infants with postnatal diagnosis had more preoperative hypotension (35% vs 14%, p = 0.004). The interactions between antenatal diagnosis and TBVs were significantly related to cognitive (p = 0.003) outcomes. Specifically, smaller TBVs were associated with lower cognitive scores in infants diagnosed postnatally; this association was attenuated in those diagnosed antenatally.

Interpretation: Antenatal diagnosis modifies associations between neonatal brain volume and 18-month cognitive outcome in infants with TGA. These findings suggest that antenatal diagnosis may be neuroprotective, possibly through improved preoperative clinical status. These data highlight the need to improve antenatal diagnosis rates.

Grants and funding

CAPMC/ CIHR/Canada