Key result
Moderate-to-severe white matter injury is linked to ~13-point lower 30-month psychomotor development scores.
Why the study?
The relationship between neonatal brain injury and neurodevelopmental outcomes in infants with critical congenital heart disease has not been established.
Does moderate-to-severe white matter injury on peri-operative MRI predict worse neurodevelopmental outcomes at 30 months in term newborns with critical congenital heart disease?
Cohort (n=104)
Does moderate-to-severe white matter injury on peri-operative MRI predict worse neurodevelopmental outcomes at 30 months in term newborns with critical congenital heart disease?
Mean Difference: -13
p-value: p=0.03 and 0.05
Moderate-to-severe white matter injury on peri-operative MRI is associated with worse motor outcomes at 30 months in infants with critical congenital heart disease, highlighting the importance of longer-term neurodevelopmental follow-up.
May inform neurodevelopmental counseling in critical CHD; leaves open whether preventing white matter injury improves psychomotor outcomes.
BACKGROUND: Brain injury (BI) is reported in 60% of newborns with critical congenital heart disease as white matter injury (WMI) or stroke. Neurodevelopmental (ND) impairments are reported in these patients. The relationship between neonatal BI and ND outcome has not been established. OBJECTIVES: This study sought to determine the association between peri-operative BI and ND outcomes in infants with single ventricle physiology (SVP) and d-transposition of the great arteries (d-TGA). METHODS: Term newborns with d-TGA and SVP had pre-operative and post-operative brain magnetic resonance imaging and ND outcomes assessed at 12 and 30 months with the Bayley Scales of Infant Development-II. BI was categorized by the brain injury severity score and WMI was quantified by volumetric analysis. RESULTS: A total of 104 infants had follow-up at 12 months and 70 had follow-up at 30 months. At 12 months, only clinical variables were associated with ND outcome. At 30 months, subjects with moderate-to-severe WMI had significantly lower Psychomotor Development Index (PDI) scores (13 points lower) as compared with those with none or minimal WMI for d-TGA and SVP (p = 0.03 and p = 0.05, respectively) after adjusting for various factors. Quantitative WMI volume was likewise associated. Stroke was not associated with outcome. The Bland-Altman limits of agreement for PDI scores at 12 and 30 months were wide (-40.3 to 31.2) across the range of mean PDI values. CONCLUSIONS: Increasing burden of WMI is associated with worse motor outcomes at 30 months for infants with critical congenital heart disease, whereas no adverse association was seen between small strokes and outcome. These results support the utility of neonatal brain magnetic resonance imaging in this population to aid in predicting later outcomes and the importance of ND follow-up beyond 1 year of age.
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Peyvandi et al. (2018) conducted a cohort in Critical congenital heart disease (d-TGA and SVP) (n=104). Moderate-to-severe white matter injury vs. None or minimal white matter injury was evaluated on Psychomotor Development Index (PDI) scores at 30 months (13 points lower, p=0.03 and 0.05). Moderate-to-severe white matter injury was associated with significantly lower Psychomotor Development Index scores (13 points lower) at 30 months compared with none or minimal injury.