TY - JOUR
T1 - Perioperative Brain Injury in Relation to Early Neurodevelopment Among Children with Severe Congenital Heart Disease
T2 - Results from a European Collaboration
AU - European Association Brain in Congenital Heart Disease (EU-ABC) consortium
AU - Neukomm, Astrid
AU - Claessens, Nathalie H.P.
AU - Bonthrone, Alexandra F.
AU - Stegeman, Raymond
AU - Feldmann, Maria
AU - Nijman, Maaike
AU - Jansen, Nicolaas J.G.
AU - Nijman, Joppe
AU - Groenendaal, Floris
AU - de Vries, Linda S.
AU - Benders, Manon J.N.L.
AU - Breur, Johannes M.P.J.
AU - Haas, Felix
AU - Bekker, Mireille N.
AU - Logeswaran, Thushiha
AU - Reich, Bettina
AU - Kottke, Raimund
AU - Dave, Hitendu
AU - Simpson, John
AU - Pushparajah, Kuberan
AU - Kelly, Christopher J.
AU - Arulkumaran, Sophie
AU - Rutherford, Mary A.
AU - Counsell, Serena J.
AU - Chew, Andrew
AU - Knirsch, Walter
AU - Sprong, Maaike C.A.
AU - van Schooneveld, Monique M.
AU - Hagmann, Cornelia
AU - Latal, Beatrice
N1 - Funding Information:
Financial relationships/disclosures/grants: This research was funded by a Consolidator Grant of the European Society of Paediatric Research (ESPR). WKZ: This research was funded by the Hartekind Foundation and Vrienden van het Wilhelmina Kinderziekenhuis Foundation. CRUCIAL-TRIAL by ZonMw. KCL: This research was funded by the Medical Research Council UK (MR/L011530/1 and MR/V002465/1), the British Heart Foundation (FS/15/55/31649), and Action Medical Research (GN2630) and was supported by the Wellcome Engineering and Physical Sciences Research Council Centre for Medical Engineering at Kings College London (WT 203148/Z/16/Z). UCZ: This research was funded by the Mäxi-Foundation Switzerland, the Anna Müller Grocholski Foundation Switzerland and the EMDO Foundation Switzerland. The sponsors were not involved in the study design, the collection, analysis, and interpretation of data, the writing of the report; and the decision to submit the paper for publication.
Publisher Copyright:
© 2023 The Authors
PY - 2024/3
Y1 - 2024/3
N2 - 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.
AB - 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.
KW - brain damage
KW - cognitive delay
KW - congenital heart defect
KW - infant
KW - motor delay
KW - MRI
KW - outcome
UR - http://www.scopus.com/inward/record.url?scp=85182435526&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2023.113838
DO - 10.1016/j.jpeds.2023.113838
M3 - Article
AN - SCOPUS:85182435526
SN - 0022-3476
VL - 266
JO - Journal of pediatrics
JF - Journal of pediatrics
M1 - 113838
ER -
