Fetal cerebrovascular resistance and neonatal EEG predict 18‐month neurodevelopmental outcome in infants with congenital heart disease

• Published in: Ultrasound in obstetrics & gynecology Vol. 40; no. 3; pp. 304 - 309
• Main Authors: Williams, I. A., Tarullo, A. R., Grieve, P. G., Wilpers, A., Vignola, E. F., Myers, M. M., Fifer, W. P.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.09.2012; Wiley; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Central Nervous System - growth & development; Central Nervous System - physiopathology; Cerebrovascular Circulation - physiology; Cognitive ability; congenital heart disease; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Electroencephalography - methods; Female; fetal cerebral Doppler; fetal cerebrovascular resistance; Fetus; Gynecology. Andrology. Obstetrics; Heart; Heart Defects, Congenital - diagnostic imaging; Humans; hypoplastic left heart syndrome; Infant, Newborn; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Cerebral Artery - diagnostic imaging; neonatal high‐density electroencephalogram; neurodevelopment; Pilot Projects; Pregnancy; Prospective Studies; tetralogy of Fallot; transposition of the great arteries; Ultrasonic investigative techniques; Ultrasonography, Doppler - methods; Ultrasonography, Prenatal - methods; Umbilical Arteries - diagnostic imaging; Doppler ultrasound study; transposition of the great arteries; Neonatal; fetal cerebral Doppler; hypoplastic left heart syndrome; Cardiovascular disease; Infant; Electroencephalography; tetralogy of Fallot; Density; Encephalon; Vascular disease; Electrodiagnosis; Vascular resistance; neurodevelopment; Fallot tetralogy; congenital heart disease; Fetus; Sonography; Human; Psychomotor development; Gynecology; fetal cerebrovascular resistance; Left Heart Hypoplasia; Congenital disease; Obstetrics; Pregnancy; Newborn; Transposition of the great vessels; Congenital cardiopathy; Predictive factor; neonatal high-density electroencephalogram
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.11144

Objectives The purpose of this study was to investigate early markers of risk for neurobehavioral compromise in survivors with congenital heart disease (CHD). Methods Pregnant women in whom a fetal CHD had been diagnosed before 24 weeks' gestational age (GA) were enrolled in this prospective pilot study for serial Doppler ultrasound assessment of the fetal middle cerebral artery (MCA) and umbilical arteries. The cerebral‐to‐placental resistance ratio (CPR) and MCA pulsatility index (PI) Z‐scores for GA were calculated. After birth, subjects underwent high‐density (128‐lead) electroencephalography (EEG), and beta frequency (12–24 Hz) band EEG power, a measure of local neural synchrony, was analyzed. Neurodevelopment was assessed at 18 months with the Bayley Scales of Infant Development (BSID)‐III. Results Thirteen subjects were enrolled: four with hypoplastic left heart syndrome (HLHS), four with transposition of the great arteries (TGA) and five with tetralogy of Fallot (TOF). Compared with subjects with normal CPR, those with CPR < 1 (n = 7) had lower mean BSID cognitive scores (91.4 ± 4.8 vs. 99.2 ± 3.8, P = 0.008). Fetal MCA‐PI Z‐score also correlated with BSID cognitive score (r = 0.589, P = 0.03) as did neonatal EEG left frontal polar (r = 0.58, P = 0.037) and left frontal (r = 0.77, P = 0.002) beta power. Furthermore, fetal Doppler measures were associated with EEG power: fetuses with CPR < 1 had lower left frontal polar (t = 2.36, P = 0.038) and left frontal (t = 2.85, P = 0.016) beta power as newborns than did fetuses with normal CPR, and fetal MCA‐PI Z‐score correlated with neonatal EEG left frontal polar (r = 0.596, P = 0.04) and left frontal (r = 0.598, P = 0.04) beta power. Conclusion In fetuses with HLHS, TGA and TOF, abnormal cerebrovascular resistance predicts decreased neonatal EEG left frontal beta power and lower 18‐month cognitive development scores. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.