Can preoperative cranial ultrasound predict early neurodevelopmental outcome in infants with congenital heart disease?

Objectives: Children with congenital heart disease (CHD) are at risk for abnormal neurodevelopment (ND). We evaluated associations between fetal Doppler and biometry measures, neonatal electroencephalogram (EEG) and 18-month ND. Methods: Fetuses with hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF) had middle cerebral (MCA) and umbilical artery (UA) Doppler velocities, as well as biometry such as head (HC) and abdominal circumference (AC), prospectively recorded at 20-25 (F1), 26-32 (F2), and 33-39 (F3) wks gestational age (GA). Pulsatility indices (PI) with GA-derived z-scores and cerebral-to-placental resistance (CPR) ratios were calculated. Neonatal high-density EEG was preformed preoperatively and the Bayley Scales of Infant Development-III were assessed at 18-months. Factor analysis was used to reduce the number of EEG predictors used in regression analysis. Results: Among 56 CHD fetuses (N=19 HLHS, N=16 TGA, N=21 TOF) who underwent preoperative EEG, ND scores are available for 33 to date. Cardiac subtype was highly associated with EEG and was considered in all models. Cognition scores were predicted by CPR< 1 ever (B=-15.7, P=0.002) and HC/AC at F2 (B=-130, P=0.013, R 2 =0.42). Language scores were predicted by UA PI z-score at F1 (B=-9.6, P=0.005, R 2 =0.27). Motor scores were predicted by UA PI z-score at F1 (B=-3.9, P=0.085), HLHS (B=-15, P<0.001), EFW%ile (B=0.374, P=0.007), and delta band right parietal and right temporal log power in active sleep (B=3.9, P=0.045, R 2 =0.61). Conclusion: Lower umbilical artery pulsatility at 20-25 wks GA was associated with higher 18-month Language and Motor scores. A diagnosis of HLHS predicted poorer Motor scores. Increased EEG power in the parietal and temporal region of the right brain predicted higher Motor scores. A larger abdomen relative to head at 26-32 wks was associated with improved cognition while diminished cerebrovascular compared with placental resistance predicted poorer cognition, similar to what has been observed in the growth restricted fetus. Further investigation is needed to confirm these hypothesis-generating findings.

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Neurodevelopmental outcome in children with congenital heart disease

Seminars in Fetal and Neonatal Medicine ◽

10.1016/j.siny.2013.04.006 ◽

2013 ◽

Vol 18 (5) ◽

pp. 279-285 ◽

Cited By ~ 28

Author(s):

Miriam Martinez-Biarge ◽

Victoria C. Jowett ◽

Frances M. Cowan ◽

Courtney J. Wusthoff

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Neurodevelopmental Outcome

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Postoperative Hyperglycemia and 4-Year Neurodevelopmental Outcome in Children Operated for Congenital Heart Disease

The Journal of Pediatrics ◽

10.1016/j.jpeds.2015.07.007 ◽

2015 ◽

Vol 167 (6) ◽

pp. 1253-1258.e1 ◽

Cited By ~ 8

Author(s):

Julia J. Krueger ◽

Barbara Brotschi ◽

Christian Balmer ◽

Vera Bernet ◽

Beatrice Latal

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Neurodevelopmental Outcome

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Neurodevelopmental outcome after surgery for acyanotic congenital heart disease

Research in Developmental Disabilities ◽

10.1016/j.ridd.2015.07.004 ◽

2015 ◽

Vol 45-46 ◽

pp. 58-68 ◽

Cited By ~ 13

Author(s):

Iemke Sarrechia ◽

Marijke Miatton ◽

Katrien François ◽

Marc Gewillig ◽

Bart Meyns ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Neurodevelopmental Outcome ◽

Acyanotic Congenital Heart Disease

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Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years: recommendations from the cardiac neurodevelopmental outcome collaborative

Cardiology in the Young ◽

10.1017/s1047951120003534 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1609-1622

Author(s):

Janice Ware ◽

Jennifer L. Butcher ◽

Beatrice Latal ◽

Anjali Sadhwani ◽

Caitlin K. Rollins ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Neurodevelopmental Outcome ◽

Heart Association ◽

Risk Identification ◽

Complex Congenital Heart Disease ◽

Assessment Instruments ◽

For Profit ◽

Developmental Domains

AbstractThis paper provides specific guidelines for the neurodevelopmental evaluation of children aged birth through 5 years with complex congenital heart disease. There is wide recognition that children with congenital heart disease are at high risk for neurodevelopmental impairments that are first apparent in infancy and often persist as children mature. Impairments among children with complex congenital heart disease cross developmental domains and affect multiple functional abilities. The guidelines provided are derived from the substantial body of research generated over the past 30 years describing the characteristic developmental profiles and the long-term trajectories of children surviving with complex congenital heart conditions. The content and the timing of the guidelines are consistent with the 2012 American Heart Association and the American Academy of Pediatrics scientific statement documenting the need for ongoing developmental monitoring and assessment from infancy through adolescence. The specific guidelines offered in this article were developed by a multidisciplinary clinical research team affiliated with the Cardiac Neurodevelopmental Outcome Collaborative, a not-for-profit organisation established to determine and implement best neurodevelopmental practices for children with congenital heart disease. The guidelines are designed for use in clinical and research applications and offer an abbreviated core protocol and an extended version that expands the scope of the evaluation. The guidelines emphasise the value of early risk identification, use of evidence-based assessment instruments, consideration of family and cultural preferences, and the importance of providing multidimensional community-based services to remediate risk.

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