Objective To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers. Study design From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Columbia (UBC), patients with aortic arch obstruction were selected and their imaging and clinical course reviewed. Results Birth characteristics were comparable between UMCU (n = 33) and UCSF/UBC (n = 54). Patients had a hypoplastic aortic arch with either coarctation/interruption or hypoplastic left heart syndrome. In subjects with prenatal diagnosis, there was a significant difference in the prevalence of white matter injury (WMI) between centers (11 of 22 [50%] at UMCU vs 4 of 30 [13%] at UCSF/UBC; P <.01). Prenatal diagnosis was protective for WMI at UCSF/UBC (13% prenatal diagnoses vs 50% postnatal diagnoses; P <.01), but not at UMCU (50% vs 46%, respectively; P >.99). Differences in clinical practice between prenatally diagnosed subjects at UMCU vs UCSF/UBC included older age at surgery, less time spent in the intensive care unit, greater use of diuretics, less use of total parenteral nutrition (P <.01), and a greater incidence of infections (P =.01). In patients diagnosed postnatally, the prevalence of WMI was similar in the 2 centers (46% at UMCU vs 50% at UCSF/UBC; P >.99). Stroke prevalence was similar in the 2 centers regardless of prenatal diagnosis (prenatal diagnosis: 4.5% at Utrecht vs 6.7% at UCSF/UBC, P =.75; postnatal diagnosis: 9.1% vs 13%, respectively, P >.99). Conclusion Prenatal diagnosis can be protective for WMI, but this protection may be dependent on specific clinical management practices that differ across centers.
Bibliographical noteFunding Information:
Supported by the Canadian Institutes of Health Research (MOP93780), the National Institutes of Health (RO1 NS40117, R01NS063876, P50 NS35902, and PO1 NS082330), National Center for Research Resources (5-M01-RR-01271), the March of Dimes Foundation (5-FY05-1231, #6-FY2009-303), the American Heart Association (0365018Y), and the Larry L. Hillblom Foundation (2002/3E). S.A. was funded by a travel grant from the European Society for Paediatric Research. S.M. is the Bloorview Children's Hospital Chair in Paediatric Neuroscience (from September 2012), and received support as a Tier 2 Canada Research Chair in Neonatal Neuroscience and a Michael Smith Foundation for Health Research Scholar award (to July 2012). The authors declare no conflicts of interest.
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