Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease: Results from a European Collaboration

Astrid Neukomm; Nathalie H P Claessens; Alexandra F Bonthrone; Raymond Stegeman; Maria Feldmann; Maaike Nijman; Nicolaas J G Jansen; Joppe Nijman; Floris Groenendaal; Linda S de Vries; Manon J N L Benders; Johannes M P J Breur; Felix Haas; Mireille N Bekker; Thushiha Logeswaran; Bettina Reich; Raimund Kottke; Hitendu Dave; John Simpson; Kuberan Pushparajah; Christopher J Kelly; Sophie Arulkumaran; Mary A Rutherford; Serena J Counsell; Andrew Chew; Walter Knirsch; Maaike C A Sprong; Monique M van Schooneveld; Cornelia Hagmann; Beatrice Latal; European Association Brain in Congenital Heart Disease (EU-ABC) consortium

doi:10.1016/j.jpeds.2023.113838

Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease: Results from a European Collaboration

J Pediatr. 2024 Mar:266:113838. doi: 10.1016/j.jpeds.2023.113838. Epub 2023 Nov 22.

Authors

Astrid Neukomm¹, Nathalie H P Claessens², Alexandra F Bonthrone³, Raymond Stegeman⁴, Maria Feldmann¹, Maaike Nijman², Nicolaas J G Jansen⁵, Joppe Nijman⁶, Floris Groenendaal⁷, Linda S de Vries⁷, Manon J N L Benders⁷, Johannes M P J Breur⁸, Felix Haas⁹, Mireille N Bekker¹⁰, Thushiha Logeswaran¹¹, Bettina Reich¹², Raimund Kottke¹³, Hitendu Dave¹⁴, John Simpson¹⁵, Kuberan Pushparajah¹⁶, Christopher J Kelly³, Sophie Arulkumaran³, Mary A Rutherford³, Serena J Counsell³, Andrew Chew³, Walter Knirsch¹⁷, Maaike C A Sprong¹⁸, Monique M van Schooneveld¹⁹, Cornelia Hagmann²⁰, Beatrice Latal¹; European Association Brain in Congenital Heart Disease (EU-ABC) consortium

Affiliations

¹ Child Development Center, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
² Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
⁴ Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
⁷ Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands; Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands.
⁸ Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
⁹ Congenital Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
¹⁰ Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
¹¹ Pediatric Heart Center, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany.
¹² Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
¹³ Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.
¹⁴ Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
¹⁵ Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom.
¹⁶ Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Pediatric Cardiology Department, Evelina Children's Hospital London, London, United Kingdom.
¹⁷ Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland.
¹⁸ Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁹ Department of Pediatric Psychology, Neuropsychology Section, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁰ Department of Neonatology and Pediatric Intensive Care, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.

PMID: 37995930
DOI: 10.1016/j.jpeds.2023.113838

Abstract

Objective: To examine the relationship between perioperative brain injury and neurodevelopment during early childhood in patients with severe congenital heart disease (CHD).

Study design: One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up.

Results: Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = -0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = -0.35).

Conclusion: Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.

Keywords: MRI; brain damage; cognitive delay; congenital heart defect; infant; motor delay; outcome.

MeSH terms

Brain / pathology
Brain Injuries* / etiology
Brain Injuries* / pathology
Child, Preschool
Heart Defects, Congenital* / complications
Heart Defects, Congenital* / surgery
Humans
Infant
Magnetic Resonance Imaging
Risk Factors

Abstract

MeSH terms

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