TY - JOUR
T1 - Brain injury and development in newborns with critical congenital heart disease
AU - Dimitropoulos, Anastasia
AU - McQuillen, Patrick S.
AU - Sethi, Viyeka
AU - Moosa, Alisha
AU - Chau, Vann
AU - Xu, Duan
AU - Brant, Rollin
AU - Azakie, Anthony
AU - Campbell, Andrew
AU - Barkovich, A. James
AU - Poskitt, Kenneth J.
AU - Miller, Steven P.
PY - 2013/7/16
Y1 - 2013/7/16
N2 - Objective: To determine the relationship between radiologically identifiable brain injuries and delayed brain development as reflected by brain metabolic and microstructural integrity. Methods: Term newborns with congenital heart disease (CHD) (120 preoperatively and 104 postoperatively) were studied with MRI to determine brain injury severity (BIS), microstructure reflected by fractional anisotropy (FA) and average diffusivity (Dav), andmetabolism reflected byN-acetylaspartate (NAA)/choline (Cho) and lactate/Cho. Brain development is characterized by increasing NAA/Cho and white matter FA, and by decreasing Dav and lactate/Cho. Results: Newly acquired brain injury was common (41%preoperative, 30%postoperative). Lower white matter FA (p 5 0.005) and lower NAA/Cho (p 5 0.01) were associated with increasing preoperative BIS. Higher neonatal illness severity scores (p 5 0.03), lower preoperative oxygen saturation (p 5 0.002), hypotension (p , 0.001), and septostomy (p 5 0.002) were also predictive of higher preoperative BIS. Preoperative FA, Dav, and NAA/Cho did not predict new postoperative BIS. Increasing preoperative BIS predicted higher postoperative Dav (p 5 0.002) and lactate/Cho (p 5 0.008). Within the postoperative scan, new brain injuries were associated with lower white matter FA (p 5 0.04). Postoperative BIS (new lesions) was associated with lower postoperative systolic (p 5 0.03) and mean (p 5 0.05) blood pressures. Conclusions: Brain injuries in newborns with CHD are strongly related to abnormalities of brain microstructural and metabolic brain development, especially preoperatively. Both newly acquired preoperative and postoperative brain injuries are related to potentially modifiable clinical risk factors.
AB - Objective: To determine the relationship between radiologically identifiable brain injuries and delayed brain development as reflected by brain metabolic and microstructural integrity. Methods: Term newborns with congenital heart disease (CHD) (120 preoperatively and 104 postoperatively) were studied with MRI to determine brain injury severity (BIS), microstructure reflected by fractional anisotropy (FA) and average diffusivity (Dav), andmetabolism reflected byN-acetylaspartate (NAA)/choline (Cho) and lactate/Cho. Brain development is characterized by increasing NAA/Cho and white matter FA, and by decreasing Dav and lactate/Cho. Results: Newly acquired brain injury was common (41%preoperative, 30%postoperative). Lower white matter FA (p 5 0.005) and lower NAA/Cho (p 5 0.01) were associated with increasing preoperative BIS. Higher neonatal illness severity scores (p 5 0.03), lower preoperative oxygen saturation (p 5 0.002), hypotension (p , 0.001), and septostomy (p 5 0.002) were also predictive of higher preoperative BIS. Preoperative FA, Dav, and NAA/Cho did not predict new postoperative BIS. Increasing preoperative BIS predicted higher postoperative Dav (p 5 0.002) and lactate/Cho (p 5 0.008). Within the postoperative scan, new brain injuries were associated with lower white matter FA (p 5 0.04). Postoperative BIS (new lesions) was associated with lower postoperative systolic (p 5 0.03) and mean (p 5 0.05) blood pressures. Conclusions: Brain injuries in newborns with CHD are strongly related to abnormalities of brain microstructural and metabolic brain development, especially preoperatively. Both newly acquired preoperative and postoperative brain injuries are related to potentially modifiable clinical risk factors.
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U2 - 10.1212/WNL.0b013e31829bfdcf
DO - 10.1212/WNL.0b013e31829bfdcf
M3 - Article
C2 - 23771484
AN - SCOPUS:84881286046
SN - 0028-3878
VL - 81
SP - 241
EP - 248
JO - Neurology
JF - Neurology
IS - 3
ER -