Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study
ObjectivesNeurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.Study designProspecti...
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| Published in | Archives of disease in childhood Vol. 104; no. 11; pp. 1042 - 1048 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
01.11.2019
BMJ Publishing Group LTD BMJ Publishing Group |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0003-9888 1468-2044 1468-2044 |
| DOI | 10.1136/archdischild-2018-314822 |
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| Abstract | ObjectivesNeurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.Study designProspective observational study.SettingSingle centre UK tertiary neonatal intensive care unit.Patients70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.Main outcome measuresPrevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.ResultsBrain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.ConclusionsCerebral injury in newborns with CHD prior to surgery is common. |
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| AbstractList | Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.OBJECTIVESNeurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.Prospective observational study.STUDY DESIGNProspective observational study.Single centre UK tertiary neonatal intensive care unit.SETTINGSingle centre UK tertiary neonatal intensive care unit.70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.PATIENTS70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.Prevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.MAIN OUTCOME MEASURESPrevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.Brain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.RESULTSBrain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.Cerebral injury in newborns with CHD prior to surgery is common.CONCLUSIONSCerebral injury in newborns with CHD prior to surgery is common. Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury. Prospective observational study. Single centre UK tertiary neonatal intensive care unit. 70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery. Prevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage. Brain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not. Cerebral injury in newborns with CHD prior to surgery is common. ObjectivesNeurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.Study designProspective observational study.SettingSingle centre UK tertiary neonatal intensive care unit.Patients70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.Main outcome measuresPrevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.ResultsBrain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.ConclusionsCerebral injury in newborns with CHD prior to surgery is common. |
| Author | Steinweg, Johannes K Tristão Pereira, Catarina Kelly, Christopher J Hughes, Emer J Victor, Suresh Arulkumaran, Sophie Rutherford, Mary A Cordero-Grande, Lucilio Hajnal, Joseph V Edwards, A David Teixeira, Rui Pedro A G Pushparajah, Kuberan Simpson, John Counsell, Serena J |
| AuthorAffiliation | 3 Paediatric Cardiology Department , Evelina London Children’s Healthcare , London , UK 1 Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering , King’s College London , London , UK 4 Congenital Heart Disease , Evelina London Children’s Hospital , London , London , UK 2 School of Imaging Sciences and Biomedical Engineering , King’s College London , London , UK |
| AuthorAffiliation_xml | – name: 1 Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering , King’s College London , London , UK – name: 2 School of Imaging Sciences and Biomedical Engineering , King’s College London , London , UK – name: 3 Paediatric Cardiology Department , Evelina London Children’s Healthcare , London , UK – name: 4 Congenital Heart Disease , Evelina London Children’s Hospital , London , London , UK |
| Author_xml | – sequence: 1 givenname: Christopher J orcidid: 0000-0002-1246-844X surname: Kelly fullname: Kelly, Christopher J organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 2 givenname: Sophie surname: Arulkumaran fullname: Arulkumaran, Sophie organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 3 givenname: Catarina surname: Tristão Pereira fullname: Tristão Pereira, Catarina organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 4 givenname: Lucilio surname: Cordero-Grande fullname: Cordero-Grande, Lucilio organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 5 givenname: Emer J surname: Hughes fullname: Hughes, Emer J organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 6 givenname: Rui Pedro A G surname: Teixeira fullname: Teixeira, Rui Pedro A G organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 7 givenname: Johannes K orcidid: 0000-0002-3366-0932 surname: Steinweg fullname: Steinweg, Johannes K organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 8 givenname: Suresh surname: Victor fullname: Victor, Suresh organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 9 givenname: Kuberan surname: Pushparajah fullname: Pushparajah, Kuberan organization: Paediatric Cardiology Department, Evelina London Children’s Healthcare, London, UK – sequence: 10 givenname: Joseph V surname: Hajnal fullname: Hajnal, Joseph V organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 11 givenname: John surname: Simpson fullname: Simpson, John organization: Congenital Heart Disease, Evelina London Children’s Hospital, London, London, UK – sequence: 12 givenname: A David orcidid: 0000-0003-4801-7066 surname: Edwards fullname: Edwards, A David organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 13 givenname: Mary A surname: Rutherford fullname: Rutherford, Mary A organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK – sequence: 14 givenname: Serena J surname: Counsell fullname: Counsell, Serena J organization: Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31243012$$D View this record in MEDLINE/PubMed |
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| Keywords | cardiac surgery neonatology neurodevelopment imaging cardiology |
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| PublicationTitle | Archives of disease in childhood |
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18 2024091723401080000_104.11.1042.49 2024091723401080000_104.11.1042.47 2024091723401080000_104.11.1042.46 2024091723401080000_104.11.1042.40 2024091723401080000_104.11.1042.45 2024091723401080000_104.11.1042.44 2024091723401080000_104.11.1042.43 2024091723401080000_104.11.1042.42 Mahle (2024091723401080000_104.11.1042.41) 2002; 106 2024091723401080000_104.11.1042.38 Cordero-Grande (2024091723401080000_104.11.1042.21) 2016; 2 2024091723401080000_104.11.1042.37 2024091723401080000_104.11.1042.36 2024091723401080000_104.11.1042.35 Sun (2024091723401080000_104.11.1042.59) 2015; 131 Wagenaar (2024091723401080000_104.11.1042.28) 2017; 182 Nattel (2024091723401080000_104.11.1042.11) 2017; 33 Hughes (2024091723401080000_104.11.1042.20) 2017; 78 2024091723401080000_104.11.1042.39 Caughey (2024091723401080000_104.11.1042.56) 2009; 176 2024091723401080000_104.11.1042.30 Rudolph (2024091723401080000_104.11.1042.58) 2016; 80 Desai (2024091723401080000_104.11.1042.48) 2015; 36 2024091723401080000_104.11.1042.1 2024091723401080000_104.11.1042.72 2024091723401080000_104.11.1042.71 2024091723401080000_104.11.1042.3 2024091723401080000_104.11.1042.2 2024091723401080000_104.11.1042.5 2024091723401080000_104.11.1042.32 2024091723401080000_104.11.1042.4 2024091723401080000_104.11.1042.31 Makropoulos (2024091723401080000_104.11.1042.33) 2018; 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| Snippet | ObjectivesNeurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate... Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden... |
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| SubjectTerms | Arteries Balloon treatment Body Weight Brain cardiac surgery Cardiac Surgical Procedures cardiology Cardiovascular disease Cardiovascular diseases Cerebellum Communication Skills Congenital diseases Coronary artery disease Executive Function Female Health risk assessment Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Heart diseases Heart Disorders Hemorrhage Humans imaging Infant, Newborn Infants Injuries Lesions Magnetic resonance imaging Male Neonates neonatology neurodevelopment Neurodevelopmental disorders Neurodevelopmental Disorders - diagnostic imaging Neurodevelopmental Disorders - physiopathology Neuroimaging Newborn babies NMR Nuclear magnetic resonance Observational studies Original Original article Pediatrics Population Distribution Population Education Preoperative Care Prospective Studies Substantia alba Surgery Transposition United Kingdom - epidemiology Young Children |
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| Title | Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study |
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