Early motor outcomes in infants with critical congenital heart disease are related to neonatal brain development and brain injury. (20th August 2021)

• Record Type: Journal Article
• Authors: Stegeman, Raymond; Sprong, Maaike C A; Breur, Johannes M P J; Groenendaal, Floris; de Vries, Linda S; Haas, Felix; van der Net, Janjaap; Jansen, Nicolaas J G; Benders, Manon J N L; Claessens, Nathalie H P
• Other Names: Toet Mona C investigator.; Dudink Jeroen investigator.; van de Gronden Charlotte M A investigator.; Flamman Wiebe R investigator.; van der Zwart Sophie A investigator.; Slieker Martijn G investigator.; Nijman Joppe investigator.; Wösten‐van Asperen Roelie M investigator.; Schappin Renske investigator.; Uniken Venema‐van Uden Monica M A investigator.; de Heus Roel investigator.
• Is Part Of: Developmental medicine & child neurology. Volume 64:Number 2(2022)
• Page Start: 192
• Page End: 199
• Publication Date: 2021-08-20
• Subjects: Child development -- Periodicals; Pediatric neurology -- Periodicals; 616.8
• DOI: 10.1111/dmcn.15024
• Languages: English
• ISSNs: 0012-1622

Abstract

Abstract : Aim: To assess the relationship between neonatal brain development and injury with early motor outcomes in infants with critical congenital heart disease (CCHD). Method: Neonatal brain magnetic resonance imaging was performed after open‐heart surgery with cardiopulmonary bypass. Cortical grey matter (CGM), unmyelinated white matter, and cerebellar volumes, as well as white matter motor tract fractional anisotropy and mean diffusivity were assessed. White matter injury (WMI) and arterial ischaemic stroke (AIS) with corticospinal tract (CST) involvement were scored. Associations with motor outcomes at 3, 9, and 18 months were corrected for repeated cardiac surgery. Results: Fifty‐one infants (31 males, 20 females) were included prospectively. Median age at neonatal surgery and postoperative brain magnetic resonance imaging was 7 days (interquartile range [IQR] 5–11d) and 15 days (IQR 12–21d) respectively. Smaller CGM and cerebellar volumes were associated with lower fine motor scores at 9 months (CGM regression coefficient=0.51, 95% confidence interval [CI]=0.15–0.86; cerebellum regression coefficient=3.08, 95% CI=1.07–5.09) and 18 months (cerebellum regression coefficient=2.08, 95% CI=0.47–5.12). The fractional anisotropy and mean diffusivity of white matter motor tracts were not related with motor scores. WMI was related to lower gross motor scores at 9 months (mean difference −0.8SD, 95% CI=−1.5 to −0.2). AIS with CST involvement increased the risk of gross motor problems and muscle tone abnormalities. Cerebral palsy ( n =3) was preceded by severe ischaemic brain injury. Interpretation: Neonatal brain development and injury are associated with fewer favourable early motor outcomes in infants with CCHD.