Alteration in Cortical Structure Mediating the Impact of Blood Oxygen‐Carrying Capacity on Gross Motor Skills in Infants With Complex Congenital Heart Disease

Congenital heart disease (CHD) is the most common congenital anomaly, leading to an increased risk of neurodevelopmental abnormalities in many children with CHD. Understanding the neurological mechanisms behind these neurodevelopmental disorders is crucial for implementing early interventions and treatments. In this study, we recruited 83 infants aged 12-26.5 months with complex CHD, along with 86 healthy controls (HCs). We collected multimodal data to explore the abnormal patterns of cerebral cortex development and explored the complex interactions among blood oxygen-carrying capacity, cortical development, and gross motor skills. We found that, compared to healthy infants, those with complex CHD exhibit significant reductions in cortical surface area development, particularly in the default mode network. Most of these developmentally abnormal brain regions are significantly correlated with the blood oxygen-carrying capacity and gross motor skills of infants with CHD. Additionally, we further discovered that the blood oxygen-carrying capacity of infants with CHD can indirectly predict their gross motor skills through cortical structures, with the left middle temporal area and left inferior temporal area showing the greatest mediation effects. This study identified biomarkers for neurodevelopmental disorders and highlighted blood oxygen-carrying capacity as an indicator of motor development risk, offering new insights for the clinical management CHD.