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

European Association Brain in Congenital Heart Disease (EU-ABC) consortium, 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 SimpsonKuberan 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

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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.

Original languageEnglish
Article number113838
JournalJournal of pediatrics
Publication statusPublished - Mar 2024


  • brain damage
  • cognitive delay
  • congenital heart defect
  • infant
  • motor delay
  • MRI
  • outcome


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