Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury
Stegeman, Raymond; Sprong, Maaike C A; Breur, Johannes M P J; Groenendaal, Floris; de Vries, Linda S; Haas, Felix; van der Net, Janjaap; Jansen, Nicolaas J G; Benders, Manon J N L; Claessens, Nathalie H P; CHD LifeSpan Study Group Utrecht
(2022) Developmental Medicine and Child Neurology, volume 64, issue 2, pp. 192 - 199
(Article)
Abstract
AIM: To assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD). METHOD: Neonatal brain magnetic resonance imaging was performed after open-heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as
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white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery. RESULTS: Fifty-one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5-11d) and 15 days (IQR 12-21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15-0.86; cerebellum regression coefficient=3.08, 95% CI=1.07-5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47-5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference -0.8SD, 95% CI=-1.5 to -0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy (n=3) was preceded by severe ischaemic brain injury. INTERPRETATION: Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.
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Keywords: Clinical Neurology, Developmental Neuroscience, Pediatrics, Perinatology, and Child Health, Journal Article
ISSN: 0012-1622
Publisher: Wiley-Blackwell
Note: Funding Information: Collaborators of the CHD LifeSpan Study Group Utrecht are as follows: Mona C Toet, Jeroen Dudink, Charlotte M A van de Gronden, Wiebe R Flamman, Sophie A van der Zwart, Martijn G Slieker, Joppe Nijman, Roelie M Wösten‐van Asperen, Renske Schappin, Monica M A Uniken Venema‐van Uden, and Roel de Heus. We thank the CHD LifeSpan Study group, which includes staff from the Departments of Obstetrics, Neonatology, Paediatric Cardiology, Paediatric Intensive Care, Congenital Cardiothoracic Surgery, Anaesthesiology, Radiology, Child Development Exercise and Physical Literacy, Medical Psychology and Social Work. The study was funded by Stichting Hartekind and Vrienden UMC Utrecht Wilhelmina Kinderziekenhuis. Funding Information: Collaborators of the CHD LifeSpan Study Group Utrecht are as follows: Mona C Toet, Jeroen Dudink, Charlotte M A van de Gronden, Wiebe R Flamman, Sophie A van der Zwart, Martijn G Slieker, Joppe Nijman, Roelie M W?sten-van Asperen, Renske Schappin, Monica M A Uniken Venema-van Uden, and Roel de Heus. We thank the CHD LifeSpan Study group, which includes staff from the Departments of Obstetrics, Neonatology, Paediatric Cardiology, Paediatric Intensive Care, Congenital Cardiothoracic Surgery, Anaesthesiology, Radiology, Child Development Exercise and Physical Literacy, Medical Psychology and Social Work. The study was funded by Stichting Hartekind and Vrienden UMC Utrecht Wilhelmina Kinderziekenhuis. Publisher Copyright: © 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.
(Peer reviewed)