A low incidence of preoperative neurosonographic abnormalities in neonates with heart defects. (September 2020)

• Record Type: Journal Article
• Authors: Jansen, Fenna A.R.; Haak, Monique C.; van Wesemael, Miriam S.; ten Harkel, A.D.J. Derk-Jan; van Lith, Jan M.M.; Blom, Nico A.; Steggerda, Sylke J.
• Is Part Of: Early human development. Volume 148(2020)
• Publication Date: 2020-09
• Subjects: Congenital heart defects -- Cerebral development -- Neonatal -- Cranial ultrasound; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2020.105097
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: Background and aim: To investigate whether neonates with prenatally detected congenital heart defects (CHD) demonstrate cerebral abnormalities on early preoperative cranial ultrasound (CUS), compared to healthy neonates, and to measure brain structures to assess brain growth and development in both groups. Study design, subjects and outcome measures: Prospective cohort study with controls. Between September 2013 and May 2016 consecutive cases of prenatally detected severe isolated CHD were included. Neonatal CUS was performed shortly after birth, before surgery and in a healthy control group. Blinded images were reviewed for brain abnormalities and various measurements of intracranial structures were compared. Results: CUS was performed in 59 healthy controls and 50 CHD cases. Physiological CUS variants were present in 54% of controls and in 52% of CHD cases. Abnormalities requiring additional monitoring (both significant and minor) were identified in four controls (7%) and five CHD neonates (10%). Significant abnormalities were only identified in four CHD neonates (8%) and never in controls. A separate analysis of an additional 8 CHD neonates after endovascular intervention demonstrated arterial stroke in two cases that underwent balloon atrioseptostomy (BAS). Cerebral measurements were smaller in CHD neonates, except for the cerebrospinal fluid measurements, which were similar to the controls. Conclusions: The prevalence of significant preoperative CUS abnormalities in CHD cases was lower than previously reported, which may be partially caused by a guarding effect of a prenatal diagnosis. Arterial stroke occurred only in cases after BAS. As expected, neonates with CHD display slightly smaller head size and cerebral growth. Highlights: Prenatally detected CHD have a low incidence of preoperative cranial abnormalities. Physiological CUS variations are common in healthy neonates. Balloon atrioseptostomy is associated with stroke in transposition of the great arteries. Increasing prenatal detection of CHD may improve neurodevelopmental outcome.