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Patel R, Makwana R, Christ C, Marchi E, Ung N, Harpell R, Miyake CY, Gropman AL, Lyon GJ, Whitehead MT. Neuroanatomical Features of NAA10- and NAA15-Related Neurodevelopmental Syndromes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.24.24309433. [PMID: 38978667 PMCID: PMC11230317 DOI: 10.1101/2024.06.24.24309433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background NAA10 -related (Ogden Syndrome) and NAA15 -related neurodevelopmental syndromes present with varying degrees of intellectual disability, hypotonia, congenital cardiac abnormalities, seizures, and delayed speech and motor development. While there is much data on the clinical manifestations of these conditions, there are few radiologic reports describing the neuroanatomical abnormalities present on imaging. Objective Our goal was to provide neuroimaging analyses for a subset of probands with NAA10- and NAA15 -related neurodevelopmental symptoms and assess severity, common radiologic anomalies, and changes over time to better understand the pathophysiology of these disease processes. Materials and Methods Neuroimaging studies from 26 probands (18 with pathogenic variants in NAA10 , 8 with pathogenic variants in NAA15 ) were collected and analyzed. Size of the cerebrum, brainstem, and cerebellum, as well as myelination, brain malformations, globus pallidus hyperintensity, brain lesions, 4th ventricle size, tegmentovermian angle, cisterna magna size, pituitary size, olfactory tract, palate arch, and choroid plexus abnormalities were analyzed. In depth medical histories were also collected on all probands, including genetic testing results and social, cognitive, and developmental history. The Vineland 3 Adaptive Behavior Scale was also administered to the parents to assess functional status of the probands. Results On average, individuals with Ogden Syndrome had 5.7 anatomical abnormalities (standard deviation (SD) = 3.0), whereas those with NAA15 related neurodevelopmental syndrome had 2.8 (SD = 2.3) (p = .02). Probands who had more anatomical abnormalities tended to score worse on Vineland assessments, suggesting a possible correlation between the two. Structural-functional anatomic differences seen were preserved such that individuals with greater defects on, for example, motor regions of their scans tested worse on motor portions of the Vineland. Probands followed longitudinally demonstrated several changes between scans, most commonly in the cerebellum, brainstem, and degree of myelination. Such changes were only observed for probands with NAA10 variants in our cohort. Conclusion Despite clinical imaging being reported as being predominantly "normal" during routine clinical care, this analysis of a cohort of patients with NAA10 -related (Ogden Syndrome) and NAA15 -related neurodevelopmental syndrome by one neuroradiologist has established a range of subtle abnormalities. We hope these findings guide future research and diagnostic studies for this patient population.
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Lee VK, Ceschin R, Reynolds WT, Meyers B, Wallace J, Landsittel D, Joseph HM, Badaly D, Gaynor JW, Licht D, Greene NH, Brady KM, Hunter JV, Chu ZD, Wilde EA, Easley RB, Andropoulos D, Panigrahy A. Postnatal Brain Trajectories and Maternal Intelligence Predict Childhood Outcomes in Complex CHD. J Clin Med 2024; 13:2922. [PMID: 38792464 PMCID: PMC11121951 DOI: 10.3390/jcm13102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: To determine whether early structural brain trajectories predict early childhood neurodevelopmental deficits in complex CHD patients and to assess relative cumulative risk profiles of clinical, genetic, and demographic risk factors across early development. Study Design: Term neonates with complex CHDs were recruited at Texas Children's Hospital from 2005-2011. Ninety-five participants underwent three structural MRI scans and three neurodevelopmental assessments. Brain region volumes and white matter tract fractional anisotropy and radial diffusivity were used to calculate trajectories: perioperative, postsurgical, and overall. Gross cognitive, language, and visuo-motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development and with the Wechsler Preschool and Primary Scale of Intelligence and Beery-Buktenica Developmental Test of Visual-Motor Integration. Multi-variable models incorporated risk factors. Results: Reduced overall period volumetric trajectories predicted poor language outcomes: brainstem ((β, 95% CI) 0.0977, 0.0382-0.1571; p = 0.0022) and white matter (0.0023, 0.0001-0.0046; p = 0.0397) at 5 years; brainstem (0.0711, 0.0157-0.1265; p = 0.0134) and deep grey matter (0.0085, 0.0011-0.0160; p = 0.0258) at 3 years. Maternal IQ was the strongest contributor to language variance, increasing from 37% at 1 year, 62% at 3 years, and 81% at 5 years. Genetic abnormality's contribution to variance decreased from 41% at 1 year to 25% at 3 years and was insignificant at 5 years. Conclusion: Reduced postnatal subcortical-cerebral white matter trajectories predicted poor early childhood neurodevelopmental outcomes, despite high contribution of maternal IQ. Maternal IQ was cumulative over time, exceeding the influence of known cardiac and genetic factors in complex CHD, underscoring the importance of heritable and parent-based environmental factors.
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Affiliation(s)
- Vincent K. Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
| | - Rafael Ceschin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA
| | - William T. Reynolds
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA
| | - Benjamin Meyers
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
| | - Julia Wallace
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
| | - Douglas Landsittel
- Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY 14260, USA;
| | - Heather M. Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY 10022, USA;
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Daniel Licht
- Perinatal Pediatrics Institute, Children’s National Hospital, Washinton, DC 20010, USA;
| | - Nathaniel H. Greene
- Anesthesiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Ken M. Brady
- Department of Pediatrics and Department of Anesthesiology, Lurie Children’s Hospital, Northwestern University, Chicago, IL 60611, USA;
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA; (J.V.H.); (Z.D.C.); (E.A.W.)
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zili D. Chu
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA; (J.V.H.); (Z.D.C.); (E.A.W.)
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elisabeth A. Wilde
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA; (J.V.H.); (Z.D.C.); (E.A.W.)
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - R. Blaine Easley
- Department of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX 77030, USA; (R.B.E.); (D.A.)
| | - Dean Andropoulos
- Department of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX 77030, USA; (R.B.E.); (D.A.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Ashok Panigrahy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA
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Provost S, Fourdain S, Vannasing P, Tremblay J, Roger K, Caron-Desrochers L, Hüsser A, Paquette N, Doussau A, Poirier N, Simard MN, Gallagher A. Language brain responses and neurodevelopmental outcome in preschoolers with congenital heart disease: A fNIRS study. Neuropsychologia 2024; 196:108843. [PMID: 38423173 DOI: 10.1016/j.neuropsychologia.2024.108843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
Neurodevelopmental disabilities affect up to 50% of survivors of congenital heart disease (CHD). Language difficulties are frequently identified during preschool period and can lead to academic, social, behavioral, and emotional difficulties. Structural brain alterations are associated with poorer neurodevelopmental outcomes in patients with CHD during infancy, childhood, and adolescence. However, evidence is lacking about the functional brain activity in children with CHD and its relationship with neurodevelopment. This study therefore aimed to characterize brain responses during a passive story-listening task in 3-year-old children with CHD, and to investigate the relationship between functional brain patterns of language processing and neurodevelopmental outcomes. To do so, we assessed hemodynamic concentration changes, using functional near-infrared spectroscopy (fNIRS), and neurodevelopmental outcomes, using the Wechsler Preschool and Primary Scale of Intelligence - 4th Edition (WPPSI-IV), in children with CHD (n = 19) and healthy controls (n = 23). Compared to their healthy peers, children with CHD had significantly lower scores on the Verbal comprehension index (VCI), the Vocabulary acquisition index (VAI), the General ability index (GAI), and the Information and the Picture Naming subtests of the WPPSI-IV. During the passive story-listening task, healthy controls showed significant hemodynamic brain responses in the temporal and the temporal posterior regions, with stronger activation in the temporal posterior than in the temporal regions. In contrast, children with CHD showed reduced activation in the temporal posterior regions compared to controls, with no difference of activation between regions. Reduced brain responses in the temporal posterior regions were also correlated with lower neurodevelopmental outcomes in both groups. This is the first study that reveals reduced brain functional responses in preschoolers with CHD during a receptive language task. It also suggests that the temporal posterior activation could be a potential brain marker of cognitive development. These findings provide support for the feasibility of identifying brain correlates of neurodevelopmental vulnerabilities in children with CHD.
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Affiliation(s)
- Sarah Provost
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Solène Fourdain
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Phetsamone Vannasing
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Julie Tremblay
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Kassandra Roger
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Laura Caron-Desrochers
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Alejandra Hüsser
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Natacha Paquette
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada
| | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Nancy Poirier
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada; Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montréal, QC, Canada; Department of Surgery, Division of Cardiac Surgery, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Noëlle Simard
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Anne Gallagher
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.
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Turner EM, Cassidy AR, Rea KE, Smith-Paine JM, Wolfe KR. [Formula: see text] The multifaceted role of neuropsychology in pediatric solid organ transplant: preliminary guidelines and strategies for clinical practice. Child Neuropsychol 2024; 30:503-537. [PMID: 37291962 DOI: 10.1080/09297049.2023.2221759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
The incidence of pediatric solid organ transplantation (SOT) has increased in recent decades due to medical and surgical advances as well as improvements in organ procurement. Survival rates for pediatric kidney, liver, and heart transplantation are above 85% but patients continue to experience complex healthcare needs over their lifetime. Long-term developmental and neuropsychological sequelae are becoming increasingly recognized in this population, although preliminary work is limited and deserves further attention. Neuropsychological weaknesses are often present prior to transplantation and may be related to underlying congenital conditions as well as downstream impact of the indicating organ dysfunction on the central nervous system. Neuropsychological difficulties pose risk for functional complications, including disruption to adaptive skill development, social-emotional functioning, quality of life, and transition to adulthood. The impact of cognitive dysfunction on health management activities (e.g., medication adherence, medical decision-making) is also an important consideration given these patients' lifelong medical needs. The primary aim of this paper is to provide preliminary guidelines and clinical strategies for assessment of neuropsychological outcomes across SOT populations for pediatric neuropsychologists and the multidisciplinary medical team, including detailing unique and shared etiologies and risk factors for impairment across organ types, and functional implications. Recommendations for clinical neuropsychological monitoring as well as multidisciplinary collaboration within pediatric SOT teams are also provided.
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Affiliation(s)
- Elise M Turner
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam R Cassidy
- Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly E Rea
- Division of Pediatric Psychology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Julia M Smith-Paine
- Division of Developmental-Behavioral Pediatrics & Psychology, Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly R Wolfe
- Department of Pediatrics, Section of Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
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Amelia P, Yosephine AG, Tobing TCL, Savira M, Viandy V, Inglin M. Association between type of congenital heart disease with child growth and development status: A cross-sectional study in Medan, Indonesia. NARRA J 2023; 3:e414. [PMID: 38450335 PMCID: PMC10915998 DOI: 10.52225/narra.v3i3.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 03/08/2024]
Abstract
Congenital heart disease (CHD) is a congenital disorder primarily affecting newborns and children. Children with CHD have a greater risk of experiencing growth delays or disorders compared to healthy children. CHD also affects various aspects of a child's development. The aim of this study was to determine the association of CHD types (cyanotic and acyanotic) with the growth and development status of children. A cross-sectional study was conducted among CHD patients at a national reference hospital in Sumatra, H. Adam Malik General Hospital in Medan, Indonesia. The children's growth status was assessed using the WHO growth chart, and the developmental condition was evaluated through the Denver Developmental Screening Test-II. Chi-squared test and Fisher's exact test were used to assess the association between the type of CHD with growth and development status in children. Using a consecutive sampling method, a total of 53 individuals were included in this study. Almost half of CHD patients (48.1%) were within the age group of 0-2 years and more than half (61.1%) were girls. Acyanotic CHD (74.1%) was more prevalent than cyanotic CHD (25.9%), with ventricular septum defect (VSD) as the most common diagnosis. A total of 37% of children with CHD suffered from malnutrition, whereas the remaining 62.9% had good nutrition. The Denver Developmental Screening Test-II indicated that 81.4% of the children were normal, whereas 18.5% had developmental disorders. Our data suggested a significant association between cyanotic CHD and poor growth status in children based on weight-for-age, weight-for-length, and body mass index (BMI)-for-age. However, there was no association between the type of CHD and developmental status in children. This study highlights that the type of CHD is significantly associated with the growth status of children, but not with their developmental status.
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Affiliation(s)
- Putri Amelia
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pediatrics, Adam Malik General Hospital, Medan, Indonesia
| | | | - Tina CL. Tobing
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Department of Pediatrics, Adam Malik General Hospital, Medan, Indonesia
| | - Maya Savira
- Department of Physiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Vincent Viandy
- Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Mark Inglin
- Department of Chemistry, University of Basel, Switzerland
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Remmele J, Pringsheim M, Nagdyman N, Oberhoffer-Fritz R, Ewert P. Cognitive function in adults with Fontan palliation versus acyanotic CHD patients and association with health-related quality of life. Cardiol Young 2023; 33:1956-1961. [PMID: 36424718 DOI: 10.1017/s1047951122003390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Impairments and developmental delay are often reported in infants and young children with CHD. However, currently, there is no data regarding cognitive abilities assessed by standardised intelligence tests in adults with CHD. This study assesses the cognitive function in Fontan patients compared with acyanotic CHD patients whether restrictions in cognitive function are present in adulthood and its association with health-related quality of life. METHODS Forty-four adult CHD (female n = 21 (47.7%); mean age 34.7 ± 11.9 years), 22 with Fontan circulation and 22 with acyanotic CHD, underwent the Wechsler Intelligence Scale for adults as patients during routine follow-up in 2018. The Medical Outcomes Study Questionnaire Short-Form 36 Health Survey (SF-36) assessed health-related quality of life. RESULTS Fontan patients showed significantly better results in the FSIQ (p = 0.020) and perceptual reasoning (p = 0.017) in comparison with patients with acyanotic CHD. All adult CHD patients showed normal IQ in subscales and full-scale IQ (FSIQ). In health-related quality of life, no association with cognitive function was found and no significant difference between both CHD groups, but trends to reduced values in acyanotic adult CHD. CONCLUSIONS Interestingly, our study results in adult Fontan patients showed that it is possible to live an adult life with normal cognitive function and good health-related quality of life with a univentricular heart. Thus, this study could be a guidepost for more in-depth studies on cognitive function in Fontan survivors. In addition, the focus should be on health-related quality of life of adult CHD with simple CHD in particular, since a reduced health-related quality of life is not only medically based.
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Affiliation(s)
- Julia Remmele
- German Heart Center of Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Munich, Germany
- Institute of Preventive Pediatrics Technical University Munich, Munich, Germany
| | - Milka Pringsheim
- German Heart Center of Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Munich, Germany
| | - Nicole Nagdyman
- German Heart Center of Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Munich, Germany
| | - Renate Oberhoffer-Fritz
- German Heart Center of Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Munich, Germany
- Institute of Preventive Pediatrics Technical University Munich, Munich, Germany
| | - Peter Ewert
- German Heart Center of Munich, Department of Congenital Heart Disease and Pediatric Cardiology, Munich, Germany
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Brossard-Racine M, Panigrahy A. Structural Brain Alterations and Their Associations With Function in Children, Adolescents, and Young Adults With Congenital Heart Disease. Can J Cardiol 2023; 39:123-132. [PMID: 36336305 DOI: 10.1016/j.cjca.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Most neonates who receive surgery for complex congenital heart disease (CHD) will survive well into adulthood, however, many of them will face functional challenges at one point during their life as a consequence of their atypical neurodevelopment. Recent advances in neuroscience and the increasing accessibility of magnetic resonance imaging have allowed numerous studies to identify the nature and extent of the brain alterations that are particular to survivors with CHD. Nevertheless, and considering that the range of outcomes is broad in this population, the functional consequences of these brain differences is not always evident. In this review, we summarize the present state of knowledge regarding the structure-function relationships evaluated in children, adolescents, and young adults with CHD using structural magnetic resonance imaging. Overall smaller total and regional brain volume, as well as lower fractional anisotropy in numerous brain regions, were frequently associated with lower cognitive outcomes including executive functioning and memory in adolescents and young adults with CHD. However, we identify several gaps in knowledge including the limited number of prospective investigations involving neonatal imaging and follow-up during childhood or adolescence, as well as the need for studies that evaluate a broader range of functional outcomes and not only the cognitive abilities. Future interdisciplinary investigations using multimodal imaging techniques could help address these gaps.
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Affiliation(s)
- Marie Brossard-Racine
- Advances in Brain and Child Development Research Laboratory, Research Institute of McGill University Health Center - Child Heald and Human Development, and School of Physical and Occupational Therapy, Department of Pediatrics - Division of Neonatology and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Ashok Panigrahy
- Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, and Clinical and Translational Imaging Research, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Patt E, Singhania A, Roberts AE, Morton SU. The Genetics of Neurodevelopment in Congenital Heart Disease. Can J Cardiol 2023; 39:97-114. [PMID: 36183910 DOI: 10.1016/j.cjca.2022.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 02/07/2023] Open
Abstract
Congenital heart disease (CHD) is the most common birth anomaly, affecting almost 1% of infants. Neurodevelopmental delay is the most common extracardiac feature in people with CHD. Many factors may contribute to neurodevelopmental risk, including genetic factors, CHD physiology, and the prenatal/postnatal environment. Damaging variants are most highly enriched among individuals with extracardiac anomalies or neurodevelopmental delay in addition to CHD, indicating that genetic factors have an impact beyond cardiac tissues in people with CHD. Potential sources of genetic risk include large deletions or duplications that affect multiple genes, such as 22q11 deletion syndrome, single genes that alter both heart and brain development, such as CHD7, and common variants that affect neurodevelopmental resiliency, such as APOE. Increased use of genome-sequencing technologies in studies of neurodevelopmental outcomes in people with CHD will improve our ability to detect relevant genes and variants. Ultimately, such knowledge can lead to improved and more timely intervention of learning support for affected children.
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Affiliation(s)
- Eli Patt
- Harvard Medical School, Boston, Massachusetts, USA
| | - Asmita Singhania
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah U Morton
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
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Neukomm A, Ehrler M, Feldmann M, Chaouch A, Knirsch W, Hagmann C, Jakab A, Latal B. Perioperative Course and Socioeconomic Status Predict Long-Term Neurodevelopment Better Than Perioperative Conventional Neuroimaging in Children with Congenital Heart Disease. J Pediatr 2022; 251:140-148.e3. [PMID: 35948191 DOI: 10.1016/j.jpeds.2022.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The objective of the study was to compare the use of neonatal conventional brain magnetic resonance imaging (MRI) with that of clinical factors and socioeconomic status (SES) to predict long-term neurodevelopment in children with severe congenital heart disease (CHD). STUDY DESIGN In this prospective cohort study, perioperative MRIs were acquired in 57 term-born infants with CHD undergoing cardiopulmonary bypass surgery during their first year of life. Total brain volume (TBV) was measured using an automated method. Brain injury severity (BIS) was assessed by an established scoring system. The neurodevelopmental outcome was assessed at 6 years using standardized test batteries. A multiple linear regression model was used for cognitive and motor outcomes with postoperative TBV, perioperative BIS, CHD complexity, length of hospital stay, and SES as covariates. RESULTS CHD diagnoses included univentricular heart defect (n = 15), transposition of the great arteries (n = 33), and acyanotic CHD (n = 9). Perioperative moderate-to-severe brain injury was detected in 15 (26%) patients. The total IQ was similar to test norms (P = .11), whereas the total motor score (P < .001) was lower. Neither postoperative TBV nor perioperative BIS predicted the total IQ, but SES (P < .001) and longer hospital stay (P = .004) did. No factor predicted the motor outcome. CONCLUSION Although the predictive value of neonatal conventional MRIs for long-term neurodevelopment is low, duration of hospital stay and SES better predict the outcome in this CHD sample. These findings should be considered in initiating early therapeutic support.
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Affiliation(s)
- Astrid Neukomm
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Maria Feldmann
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Aziz Chaouch
- Division of Biostatistics, Center of Primary Care and Public Health (Unisanté) Lausanne, Lausanne, Switzerland
| | - Walter Knirsch
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Andras Jakab
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Center for MR Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
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10
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Steger C, Feldmann M, Borns J, Hagmann C, Latal B, Held U, Jakab A, O'Gorman Tuura R, Knirsch W. Neurometabolic changes in neonates with congenital heart defects and their relation to neurodevelopmental outcome. Pediatr Res 2022; 93:1642-1650. [PMID: 35995938 PMCID: PMC10172141 DOI: 10.1038/s41390-022-02253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/07/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Altered neurometabolite ratios in neonates undergoing cardiac surgery for congenital heart defects (CHD) may serve as a biomarker for altered brain development and neurodevelopment (ND). METHODS We analyzed single voxel 3T PRESS H1-MRS data, acquired unilaterally in the left basal ganglia and white matter of 88 CHD neonates before and/or after neonatal cardiac surgery and 30 healthy controls. Metabolite ratios to Creatine (Cr) included glutamate (Glu/Cr), myo-Inositol (mI/Cr), glutamate and glutamine (Glx/Cr), and lactate (Lac/Cr). In addition, the developmental marker N-acetylaspartate to choline (NAA/Cho) was evaluated. All children underwent ND outcome testing using the Bayley Scales of Infant and Toddler Development Third Edition (BSID-III) at 1 year of age. RESULTS White matter NAA/Cho ratios were lower in CHD neonates compared to healthy controls (group beta estimate: -0.26, std. error 0.07, 95% CI: -0.40 - 0.13, p value <0.001, FDR corrected p value = 0.010). We found no correlation between pre- or postoperative white matter NAA/Cho with ND outcome while controlling for socioeconomic status and CHD diagnosis. CONCLUSION Reduced white matter NAA/Cho in CHD neonates undergoing cardiac surgery may reflect a delay in brain maturation. Further long-term MRS studies are needed to improve our understanding of the clinical impact of altered metabolites on brain development and outcome. IMPACT NAA/Cho was reduced in the white matter, but not the gray matter of CHD neonates compared to healthy controls. No correlation to the 1-year neurodevelopmental outcome (Bayley-III) was found. While the rapid change of NAA/Cho with age might make it a sensitive marker for a delay in brain maturation, the relationship to neurodevelopmental outcome requires further investigation.
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Affiliation(s)
- Céline Steger
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland.,Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital, Zürich, Switzerland.,Children's Research Center, University Children's Hospital, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Maria Feldmann
- Children's Research Center, University Children's Hospital, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.,University of Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital, Zurich, Switzerland
| | - Julia Borns
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital, Zürich, Switzerland.,Children's Research Center, University Children's Hospital, Zürich, Switzerland.,Pediatric Cardiology, Inselspital Bern, Bern, Switzerland
| | - Cornelia Hagmann
- Children's Research Center, University Children's Hospital, Zürich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Zurich, Switzerland
| | - Beatrice Latal
- Children's Research Center, University Children's Hospital, Zürich, Switzerland.,University of Zurich, Zurich, Switzerland.,Child Development Center, University Children's Hospital, Zurich, Switzerland
| | - Ulrike Held
- University of Zurich, Zurich, Switzerland.,Department of Epidemiology, Biostatistics and Prevention Institute UZH, Zürich, Switzerland
| | - András Jakab
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Ruth O'Gorman Tuura
- Center for MR-Research, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital, Zürich, Switzerland. .,Children's Research Center, University Children's Hospital, Zürich, Switzerland. .,University of Zurich, Zurich, Switzerland.
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11
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Aberrant White Matter Organization Correlated With Neurodevelopment Outcomes in Tetralogy of Fallot: An Atlas-Based Diffusion Tensor Imaging Study. Pediatr Neurol 2022; 133:15-20. [PMID: 35749819 DOI: 10.1016/j.pediatrneurol.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/12/2022] [Accepted: 05/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND White matter injury (WMI) and impaired neurodevelopment are common in children with congenital heart disease. However, the effect of WMI on neurodevelopmental outcomes is still rarely reported. In this study, we aimed to investigate microstructural changes in white matter (WM) and its relationship with neurodevelopmental outcomes and further explore the underlying neurophysiological mechanisms of neurocognitive impairments in the tetralogy of Fallot (ToF). METHOD Diffusion tensor imaging (DTI) data were acquired in preschool-aged children with ToF (n = 29) and normal controls (NC, n = 19), and neurodevelopmental assessments were performed with the Wechsler Preschool and Primary Scale of Intelligence in ToF. The differences in DTI metrics including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were evaluated between ToF and NC. Correlations between WM microstructural changes and neurodevelopmental outcomes were further analyzed. RESULTS Significant WM differences were found in the uncinate fasciculus, cingulum hippocampus, superior longitudinal fasciculus, and corticospinal tract between children with ToF and NC. Impaired WM integrity was correlated with the verbal comprehension index and working memory index in ToF. CONCLUSIONS This study demonstrated WM microstructure injury, and this injury is related to worse language and working memory performance in preschool-aged children with ToF. These findings suggested that DTI metrics may be a potential biomarker of neurocognitive impairments in ToF and can be used to predict future neurodevelopmental outcomes, which also provide new insights into the underlying neurophysiological mechanisms of neurocognitive impairments in ToF.
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12
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Sadhwani A, Wypij D, Rofeberg V, Gholipour A, Mittleman M, Rohde J, Velasco-Annis C, Calderon J, Friedman KG, Tworetzky W, Grant PE, Soul JS, Warfield SK, Newburger JW, Ortinau CM, Rollins CK. Fetal Brain Volume Predicts Neurodevelopment in Congenital Heart Disease. Circulation 2022; 145:1108-1119. [PMID: 35143287 PMCID: PMC9007882 DOI: 10.1161/circulationaha.121.056305] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurodevelopmental impairment is common in children with congenital heart disease (CHD), but postnatal variables explain only 30% of the variance in outcomes. To explore whether the antecedents for neurodevelopmental disabilities might begin in utero, we analyzed whether fetal brain volume predicted subsequent neurodevelopmental outcome in children with CHD. METHODS Fetuses with isolated CHD and sociodemographically comparable healthy control fetuses underwent fetal brain magnetic resonance imaging and 2-year neurodevelopmental evaluation with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and the Adaptive Behavior Assessment System, Third Edition (ABAS-3). Hierarchical regression evaluated potential predictors of Bayley-III and ABAS-3 outcomes in the CHD group, including fetal total brain volume adjusted for gestational age and sex, sociodemographic characteristics, birth measures, and medical history. RESULTS The CHD group (n=52) had lower Bayley-III cognitive, language, and motor scores than the control group (n=26), but fetal brain volumes were similar. Within the CHD group, larger fetal total brain volume correlated with higher Bayley-III cognitive, language, and motor scores and ABAS-3 adaptive functioning scores (r=0.32-0.47; all P<0.05), but this was not noted in the control group. Fetal brain volume predicted 10% to 21% of the variance in neurodevelopmental outcome measures in univariate analyses. Multivariable models that also included social class and postnatal factors explained 18% to 45% of the variance in outcome, depending on developmental domain. Moreover, in final multivariable models, fetal brain volume was the most consistent predictor of neurodevelopmental outcome across domains. CONCLUSIONS Small fetal brain volume is a strong independent predictor of 2-year neurodevelopmental outcomes and may be an important imaging biomarker of future neurodevelopmental risk in CHD. Future studies are needed to support this hypothesis. Our findings support inclusion of fetal brain volume in risk stratification models and as a possible outcome in fetal neuroprotective intervention studies.
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Affiliation(s)
- Anjali Sadhwani
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - David Wypij
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
| | - Ali Gholipour
- Department of Radiology, Boston Children’s Hospital, Boston, MA
- Department of Radiology, Harvard Medical School, Boston, MA
| | | | - Julia Rohde
- Department of Neurology, Boston Children’s Hospital, Boston, MA
| | | | - Johanna Calderon
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kevin G. Friedman
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - P. Ellen Grant
- Department of Radiology, Boston Children’s Hospital, Boston, MA
- Department of Radiology, Harvard Medical School, Boston, MA
| | - Janet S. Soul
- Department of Neurology, Boston Children’s Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | | | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Caitlin K. Rollins
- Department of Neurology, Boston Children’s Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
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13
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Adaptive Functioning in Adolescents with Congenital Heart Disease Referred for Neurodevelopmental Follow-Up. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022. [DOI: 10.1007/s40817-022-00120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Altered brain structure in preschool-aged children with tetralogy of Fallot. Pediatr Res 2022; 93:1321-1327. [PMID: 35194163 DOI: 10.1038/s41390-022-01987-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/04/2022] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neurodevelopmental abnormalities are prevalent in children with tetralogy of Fallot. Our aim was to investigate the structural brain alterations of preschool-aged children with tetralogy of Fallot and its correlation with neurodevelopmental outcome. METHODS T1-weighted structural images were obtained from 25 children with tetralogy of Fallot who had undergone cardiopulmonary bypass surgery and from 24 normal controls. Cortical morphological indices including gray matter volume, cortical thickness, sulcal depth, gyrification, and cortical surface complexity were compared between the two groups. Neurodevelopmental assessments of the children with tetralogy of Fallot were performed with the Wechsler Preschool and Primary Scale of Intelligence. RESULTS Cortical morphological differences between groups were distributed throughout the right caudal middle frontal gyrus, right fusiform gyrus, right lateral occipital gyrus, right precuneus, and left inferior parietal lobule. Among children with tetralogy of Fallot, altered cortical structures were correlated with the visual spatial index, working memory index, and perioperative variables. CONCLUSION Our results suggested that abnormal cortical structure in preschool-aged children with tetralogy of Fallot may be the persistent consequence of delayed cortical development in fetuses and cortical morphology can be used as an early potential biomarker to capture regional brain abnormalities that are relevant to neurodevelopmental outcomes. IMPACT Altered cortical structures in preschool-aged children with ToF were correlated with both neurodevelopmental outcomes and clinical risk factors. Cortical morphology can be used as an effective tool to evaluate neuroanatomical changes and detect underlying neural mechanisms in ToF patients. Abnormal cortical structure may be the continuous consequence of delayed fetal brain development in children with ToF.
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15
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Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes. Pediatr Res 2022; 91:787-794. [PMID: 33864014 PMCID: PMC9064799 DOI: 10.1038/s41390-021-01521-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
Children with congenital heart disease (CHD) are living longer due to effective medical and surgical management. However, the majority have neurodevelopmental delays or disorders. The role of the placenta in fetal brain development is unclear and is the focus of an emerging field known as neuroplacentology. In this review, we summarize neurodevelopmental outcomes in CHD and their brain imaging correlates both in utero and postnatally. We review differences in the structure and function of the placenta in pregnancies complicated by fetal CHD and introduce the concept of a placental inefficiency phenotype that occurs in severe forms of fetal CHD, characterized by a myriad of pathologies. We propose that in CHD placental dysfunction contributes to decreased fetal cerebral oxygen delivery resulting in poor brain growth, brain abnormalities, and impaired neurodevelopment. We conclude the review with key areas for future research in neuroplacentology in the fetal CHD population, including (1) differences in structure and function of the CHD placenta, (2) modifiable and nonmodifiable factors that impact the hemodynamic balance between placental and cerebral circulations, (3) interventions to improve placental function and protect brain development in utero, and (4) the role of genetic and epigenetic influences on the placenta-heart-brain connection. IMPACT: Neuroplacentology seeks to understand placental connections to fetal brain development. In fetuses with CHD, brain growth abnormalities begin in utero. Placental microstructure as well as perfusion and function are abnormal in fetal CHD.
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16
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Alam S, Ilardi D, Cadiz E, Kelleman M, Oster ME. Impact of Cardiac Neurodevelopmental Evaluation for Children with Congenital Heart Disease. Dev Neuropsychol 2021; 47:32-41. [PMID: 34894903 DOI: 10.1080/87565641.2021.2009482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with congenital heart disease (CHD) are at increased risk for neurodevelopmental delays. This study of school-aged children with single ventricle CHD compared access to services for those who did and did not complete an evaluation. Children completing an evaluation had more academic services, including an Individualized Education Plan (66% vs 34%,P = .017), small group academic instruction (54% vs 20%,P = .01), any instructional supports (77% vs 44%,P = .008). A barrier to not completing the evaluation was lack of knowledge about the Cardiac Neurodevelopmental Program (82%). The neurodevelopmental evaluation is an impactful tool that can increase access to school services in vulnerable CHD patients.
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Affiliation(s)
- Sabikha Alam
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
| | - Dawn Ilardi
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States.,Department of Neuropsychology, Children's Healthcare of Atlanta, and Department of Rehabilitation Medicine, Emory University, Atlanta, United States
| | - Emilia Cadiz
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
| | - Michael Kelleman
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
| | - Matthew E Oster
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, United States
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17
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Brain MRI Radiomics Analysis of School-Aged Children with Tetralogy of Fallot. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2380346. [PMID: 34745322 PMCID: PMC8570890 DOI: 10.1155/2021/2380346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022]
Abstract
Introduction Radiomics could be potential imaging biomarkers by capturing and analyzing the features. Children and adolescents with CHD have worse neurodevelopmental and functional outcomes compared with their peers. Early diagnosis and intervention are the necessity to improve neurological outcomes in CHD patients. Methods School-aged TOF patients and their healthy peers were recruited for MRI and neurodevelopmental assessment. LASSO regression was used for dimension reduction. ROC curve graph showed the performance of the model. Results Six related features were finally selected for modeling. The final model AUC was 0.750. The radiomics features can be potential significant predictors for neurodevelopmental diagnoses. Conclusion The radiomics on the conventional MRI can help predict the neurodevelopment of school-aged children and provide parents with rehabilitation advice as early as possible.
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18
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Bonthrone AF, Kelly CJ, Ng IHX, Counsell SJ. MRI studies of brain size and growth in individuals with congenital heart disease. Transl Pediatr 2021; 10:2171-2181. [PMID: 34584889 PMCID: PMC8429874 DOI: 10.21037/tp-20-282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Congenital heart disease (CHD) is the most frequent congenital abnormality. Most infants born with CHD now survive. However, survivors of CHD are at increased risk of neurodevelopmental impairment, which may be due to impaired brain development in the fetal and neonatal period. Magnetic resonance imaging (MRI) provides objective measures of brain volume and growth. Here, we review MRI studies assessing brain volume and growth in individuals with CHD from the fetus to adolescence. Smaller brain volumes compared to healthy controls are evident from around 30 weeks gestation in fetuses with CHD and are accompanied by increased extracerebral cerebrospinal fluid. This impaired brain growth persists after birth and throughout childhood to adolescence. Risk factors for impaired brain growth include reduced cerebral oxygen delivery in utero, longer time to surgery and increased hospital stay. There is increasing evidence that smaller total and regional brain volumes in this group are associated with adverse neurodevelopmental outcome. However, to date, few studies have assessed the association between early measures of cerebral volume and neurodevelopmental outcome in later childhood. Large prospective multicentre studies are required to better characterise the relationship between brain volume and growth, clinical risk factors and subsequent cognitive, motor, and behavioural impairments in this at-risk population.
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Affiliation(s)
- Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Isabel H X Ng
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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19
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Wu J, Sun T, Yu B, Li Z, Wu Q, Wang Y, Qian Z, Zhang Y, Jiang L, Wei H. Age-specific structural fetal brain atlases construction and cortical development quantification for chinese population. Neuroimage 2021; 241:118412. [PMID: 34298085 DOI: 10.1016/j.neuroimage.2021.118412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Accepted: 07/19/2021] [Indexed: 01/14/2023] Open
Abstract
In magnetic resonance imaging (MRI) studies of fetal brain development, structural brain atlases usually serve as essential references for the fetal population. Individual images are usually normalized into a common or standard space for analysis. However, the existing fetal brain atlases are mostly based on MR images obtained from Caucasian populations and thus are not ideal for the characterization of the fetal Chinese population due to neuroanatomical differences related to genetic factors. In this paper, we use an unbiased template construction algorithm to create a set of age-specific Chinese fetal atlases between 21-35 weeks of gestation from 115 normal fetal brains. Based on the 4D spatiotemporal atlas, the morphological development patterns, e.g., cortical thickness, cortical surface area, sulcal and gyral patterns, were quantified. The fetal brain abnormalities were detected when referencing the age-specific template. Additionally, a direct comparison of the Chinese fetal atlases and Caucasian fetal atlases reveals dramatic anatomical differences, mainly in the medial frontal and temporal regions. After applying the Chinese and Caucasian fetal atlases separately to an independent Chinese fetal brain dataset, we find that the Chinese fetal atlases result in significantly higher accuracy than the Caucasian fetal atlases in guiding brain tissue segmentation. These results suggest that the Chinese fetal brain atlases are necessary for quantitative analysis of the typical and atypical development of the Chinese fetal population in the future. The atlases with their parcellations are now publicly available at https://github.com/DeepBMI/FBA-Chinese.
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Affiliation(s)
- Jiangjie Wu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Boliang Yu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Zhenghao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Wu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Yutong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoxia Qian
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yuyao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Ling Jiang
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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20
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Zheng BH, Liu XM, Zhao P, Li P. A review on neurodevelopmental abnormalities in congenital heart disease: focus on minimizing the deleterious effects on patients. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1899992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Bai-hong Zheng
- Department of Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin, People’s Republic of China
| | - Xiu-min Liu
- Department of Clinical Laboratory, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Peng Zhao
- Department of Anesthesiology, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Ping Li
- Department of Developmental Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin, People’s Republic of China
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21
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Infants with congenital heart defects have reduced brain volumes. Sci Rep 2021; 11:4191. [PMID: 33603031 PMCID: PMC7892565 DOI: 10.1038/s41598-021-83690-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/04/2021] [Indexed: 01/18/2023] Open
Abstract
Children with congenital heart defects (CHDs) have increased risk of cognitive disabilities for reasons not fully understood. Previous studies have indicated signs of disrupted fetal brain growth from mid-gestation measured with ultrasound and magnetic resonance imaging (MRI) and infants with CHDs have decreased brain volumes at birth. We measured the total and regional brain volumes of infants with and without CHDs using MRI to investigate, if certain areas of the brain are at particular risk of disrupted growth. MRI brain volumetry analyses were performed on 20 infants; 10 with- (postmenstrual age 39–54 weeks, mean 44 weeks + 5 days) and 10 without CHDs (postmenstrual age 39–52 weeks, mean 43 weeks + 5 days). In six infants with- and eight infants without CHDs grey and white matter were also differentiated. Infants with CHDs had smaller brains (48 ml smaller; 95% CI, 6.1–90; p = 0.03), cerebrums (37.8 ml smaller; 95% CI, 0.8–74.8; p = 0.04), and cerebral grey matter (25.8 ml smaller; 95% CI, 3.5–48; p = 0.03) than infants without CHD. Brain volume differences observed within weeks after birth in children with CHDs confirm that the brain impact, which increase the risk of cognitive disabilities, may begin during pregnancy.
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22
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Naef N, Schlosser L, Brugger P, Greutmann M, Oxenius A, Wehrle F, Kottke R, Latal B, O'Gorman RT. Brain volumes in adults with congenital heart disease correlate with executive function abilities. Brain Imaging Behav 2021; 15:2308-2316. [PMID: 33515180 PMCID: PMC8500877 DOI: 10.1007/s11682-020-00424-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/02/2022]
Abstract
Congenital heart disease is the most common birth defect, and patients are at risk for neurodevelopmental impairment and brain abnormalities. Yet, little is known about the link between brain volumes and cognitive function in adults with congenital heart disease. Forty-four patients and 53 controls between 18 and 32 years underwent brain magnetic resonance imaging and cognitive testing, assessed with an intelligence quotient and executive function global score. Associations between brain volumes and cognitive function were calculated using linear models. Cognitive function in patients was within the normal range (intelligence quotient: 97.74 (10.76)). Total brain volume was significantly smaller in patients compared to controls (1067.26 (113.53) vs 1113.04 (97.88) cm3, P < 0.01), irrespective of cardiac factors (heart defect complexity, cyanosis, cardiopulmonary bypass: all P > 0.4). After adjusting for total brain volume, only corpus callosum volume remained significantly smaller (P = 0.03). Smaller total brain volume was associated with poorer overall executive functioning (P = 0.02) and inhibition (P < 0.01), in both patients and controls. The association between total brain volume and overall executive functioning was moderated by parental socioeconomic status (lower socioeconomic status was associated with a stronger association between brain volume and EF; interaction P = 0.03). In adults with congenital heart disease, despite normal intelligence quotient, brain volume alterations persist into adulthood and are related to executive functioning, in particular inhibitory control. Adults coming from low socioeconomic background and with altered brain volumes are especially vulnerable and should thus be followed-up during adulthood to ensure optimal social and educational support.
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Affiliation(s)
- Nadja Naef
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75;, CH -8032, Zurich, Switzerland
| | - Ladina Schlosser
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75;, CH -8032, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Brugger
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Oxenius
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Flavia Wehrle
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75;, CH -8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raimund Kottke
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75;, CH -8032, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Ruth Tuura O'Gorman
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,MR Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Ehrler M, von Rhein M, Schlosser L, Brugger P, Greutmann M, Kretschmar O, Latal B, Tuura O'Gorman R. Microstructural alterations of the corticospinal tract are associated with poor motor function in patients with severe congenital heart disease. NEUROIMAGE: CLINICAL 2021; 32:102885. [PMID: 34911191 PMCID: PMC8628013 DOI: 10.1016/j.nicl.2021.102885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 10/25/2022] Open
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24
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Barkhuizen M, Abella R, Vles JSH, Zimmermann LJI, Gazzolo D, Gavilanes AWD. Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease. Pediatr Cardiol 2021; 42:1-18. [PMID: 33373013 PMCID: PMC7864813 DOI: 10.1007/s00246-020-02440-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022]
Abstract
Congenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.
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Affiliation(s)
- Melinda Barkhuizen
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Raul Abella
- Department of Pediatric Cardiac Surgery, University of Barcelona, Vall d'Hebron, Spain
| | - J S Hans Vles
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diego Gazzolo
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Fetal, Maternal and Neonatal Health, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Antonio W D Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Guayaquil, Guayaquil, Ecuador.
- Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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25
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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. Cardiol Young 2020; 30:1609-1622. [PMID: 33143781 DOI: 10.1017/s1047951120003534] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 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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26
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Neurodevelopmental evaluation for school-age children with congenital heart disease: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2020; 30:1623-1636. [PMID: 33143766 DOI: 10.1017/s1047951120003546] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In 2012, the American Heart Association and the American Academy of Paediatrics released a scientific statement with guidelines for the evaluation and management of the neurodevelopmental needs of children with CHD. Decades of outcome research now highlight a range of cognitive, learning, motor, and psychosocial vulnerabilities affecting individuals with CHD across the lifespan. The number of institutions with Cardiac Neurodevelopmental Follow-Up Programmes and services for CHD is growing worldwide. This manuscript provides an expanded set of neurodevelopmental evaluation strategies and considerations for professionals working with school-age children with CHD. Recommendations begin with the referral process and access to the evaluation, the importance of considering medical risk factors (e.g., genetic disorders, neuroimaging), and the initial clinical interview with the family. The neurodevelopmental evaluation should take into account both family and patient factors, including the child/family's primary language, country of origin, and other cultural factors, as well as critical stages in development that place the child at higher risk. Domains of assessment are reviewed with emphasis on target areas in need of evaluation based on current outcome research with CHD. Finally, current recommendations are made for assessment batteries using a brief core battery and an extended comprehensive clinical battery. Consistent use of a recommended assessment battery will increase opportunities for research collaborations, and ultimately help improve the quality of care for families and children with CHD.
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27
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Abstract
Most children born with even the most critical forms of CHD are now surviving well into adulthood. However, with increased survival has come increased recognition of the diverse neurobehavioural and psychosocial challenges these children experience. Among these challenges are deficits in executive function skills, including inhibitory control, working memory, and cognitive flexibility. Over the past several years, whereas inhibitory control and working memory deficits have garnered particular attention among clinicians and interventionists, relatively less attention has been paid to cognitive flexibility. This is unfortunate given both the high prevalence of cognitive flexibility deficits observed in children and adolescents with critical CHD, and also the far-reaching relevance of cognitive flexibility in helping individuals achieve optimal quality of life across the lifespan. This paper reviews the construct of cognitive flexibility, including its definition, development, measurement, and neuroanatomical basis, provides a summary of how cognitive flexibility is affected by CHD, and offers evidence-based recommendations to systematically support the development of cognitive flexibility within the context of CHD.
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28
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Abstract
INTRODUCTION While the overall prevalence of autism is 1.7% in the United States of America, research has demonstrated a two- to five-fold increase in CHD. The Cardiac Neurodevelopmental Outcome Collaborative recommends screening for autism from infancy through adolescence. This study investigated the frequency of autism concerns at a single Cardiac Neurodevelopmental Program and examined current clinical practice as a way to improve quality of care. MATERIALS AND METHODS Patients (n = 134; mean age = 9.0 years) included children with high-risk CHD who completed a neurodevelopmental evaluation following a formalised referral to the Cardiac Neurodevelopmental Program between 2018 and 2019. Retrospective chart review included parent report on the Behaviour Assessment System for Children-3 and Adaptive Behaviour Assessment System-3. Descriptive and correlation analyses were completed. RESULTS In this sample, 11.2% presented with autism-related concerns at referral, 2 were diagnosed with autism, 9 were referred to an autism specialist (6 confirmed diagnosis; 3 not completed). Thus, at least 5.9% of the sample were diagnosed with autism following thorough clinical evaluation. Analyses showed atypicality, along with deficient adaptability, leisure, social, and communication skills. Frequency of early intervention, school supports, and relation with comorbidities are reported. DISCUSSION Prior to assessment recommendations by the Cardiac Neurodevelopmental Outcome Collaborative, autism screening may not be completed systematically in clinical care for CHD. The current sample demonstrates a high frequency of autism in the typically referred clinical sample. Commonly used parent-report measures may reveal concerns but will not help diagnosis. Systematic use of an autism screener is essential.
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29
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Morton SU, Maleyeff L, Wypij D, Yun HJ, Newburger JW, Bellinger DC, Roberts AE, Rivkin MJ, Seidman JG, Seidman CE, Grant PE, Im K. Abnormal Left-Hemispheric Sulcal Patterns Correlate with Neurodevelopmental Outcomes in Subjects with Single Ventricular Congenital Heart Disease. Cereb Cortex 2020; 30:476-487. [PMID: 31216004 PMCID: PMC7306172 DOI: 10.1093/cercor/bhz101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/02/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022] Open
Abstract
Neurodevelopmental abnormalities are the most common noncardiac complications in patients with congenital heart disease (CHD). Prenatal brain abnormalities may be due to reduced oxygenation, genetic factors, or less commonly, teratogens. Understanding the contribution of these factors is essential to improve outcomes. Because primary sulcal patterns are prenatally determined and under strong genetic control, we hypothesized that they are influenced by genetic variants in CHD. In this study, we reveal significant alterations in sulcal patterns among subjects with single ventricle CHD (n = 115, 14.7 ± 2.9 years [mean ± standard deviation]) compared with controls (n = 45, 15.5 ± 2.4 years) using a graph-based pattern-analysis technique. Among patients with CHD, the left hemisphere demonstrated decreased sulcal pattern similarity to controls in the left temporal and parietal lobes, as well as the bilateral frontal lobes. Temporal and parietal lobes demonstrated an abnormally asymmetric left-right pattern of sulcal basin area in CHD subjects. Sulcal pattern similarity to control was positively correlated with working memory, processing speed, and executive function. Exome analysis identified damaging de novo variants only in CHD subjects with more atypical sulcal patterns. Together, these findings suggest that sulcal pattern analysis may be useful in characterizing genetically influenced, atypical early brain development and neurodevelopmental risk in subjects with CHD.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Lara Maleyeff
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - David Wypij
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Hyuk Jin Yun
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - David C Bellinger
- Department of Neurology
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Amy E Roberts
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Michael J Rivkin
- Department of Neurology
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Radiology
- Stroke and Cerebrovascular Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - J G Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland 20815, USA
| | - P Ellen Grant
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Radiology
| | - Kiho Im
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
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Jakab A, Meuwly E, Feldmann M, Rhein MV, Kottke R, O'Gorman Tuura R, Latal B, Knirsch W. Left temporal plane growth predicts language development in newborns with congenital heart disease. Brain 2020; 142:1270-1281. [PMID: 30957841 DOI: 10.1093/brain/awz067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 01/07/2023] Open
Abstract
Congenital heart defects are the most common congenital anomalies, accounting for a third of all congenital anomaly cases. While surgical correction dramatically improved survival rates, the lag behind normal neurodevelopment appears to persist. Deficits in higher cognitive functions are particularly common, including developmental delay in communication and oral-motor apraxia. It remains unclear whether the varying degree of cognitive developmental delay is reflected in variability in brain growth patterns. To answer this question, we aimed to investigate whether the rate of regional brain growth is correlated with later life neurodevelopment. Forty-four newborns were included in our study, of whom 33 were diagnosed with dextro-transposition of the great arteries and 11 with other forms of severe congenital heart defects. During the first month of life, neonates underwent corrective or palliative cardiovascular bypass surgery, pre- and postoperative cerebral MRI were performed 18.7 ± 7.03 days apart. MRI was performed in natural sleep on a 3.0 T scanner using an 8-channel head coil, fast spin-echo T2-weighted anatomical sequences were acquired in three planes. Based on the principles of deformation-based morphometry, we calculated brain growth rate maps reflecting average daily growth occurring between pre- and postoperative brain images. An explorative, whole-brain, threshold-free cluster enhancement analysis revealed strong correlation between the growth rate of the Heschl's gyrus, anterior planum temporale and language score at 12 months of age, corrected for demographic variables (P = 0.018, t = 5.656). No significant correlation was found between brain growth rates and motor or cognitive scores. Post hoc analysis showed that the length of hospitalization interacted with this correlation, longer hospitalization resulted in faster enlargement of the internal CSF spaces. Our longitudinal cohort study provides evidence for the early importance of left-dominant perisylvian regions in auditory and language development before direct postnatal exposure to native language. In congenital heart disease patients, the perioperative period results in a critical variability of brain growth rate in this region, which is a reliable neural correlate of language development at 1 year of age.
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Affiliation(s)
- Andras Jakab
- Centre for MR Research, University Children's Hospital Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Eliane Meuwly
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maria Feldmann
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael von Rhein
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ruth O'Gorman Tuura
- Centre for MR Research, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
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Zaidi AH, Newburger JW, Wypij D, Stopp C, Watson CG, Friedman KG, Rivkin MJ, Rollins CK. Ascending Aorta Size at Birth Predicts White Matter Microstructure in Adolescents Who Underwent Fontan Palliation. J Am Heart Assoc 2019; 7:e010395. [PMID: 30561261 PMCID: PMC6405606 DOI: 10.1161/jaha.118.010395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background In neonates with single ventricle, smaller ascending aorta diameter is associated with cerebral white matter ( WM ) microstructural abnormalities. We sought to determine whether this association persists into adolescence. Methods and Results Ascending aorta Z scores were obtained from first postnatal echocardiogram. Brain magnetic resonance imaging with diffusion tensor imaging was acquired in adolescence and used to obtain fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity in 33 WM tract regions of interest. Partial Pearson correlation coefficients were evaluated for associations between ascending aorta Z scores and WM microstructure measures, adjusting for sex, age at magnetic resonance imaging, scanner field strength, and Norwood status. Among 42 single ventricle patients aged 10 to 19 years, 31 had undergone the Norwood procedure as neonates. Lower ascending aorta Z scores were associated with lower fractional anisotropy in bilateral pontine crossing tracts ( P=0.02), inferior fronto-occipital fasciculus ( P=0.02), and inferior longitudinal fasciculus ( P=0.01); left cingulum-cingulate bundle ( P=0.01), superior longitudinal fasciculus ( P=0.04), and superior longitudinal fasciculus-temporal component ( P=0.01); and right cingulum-hippocampal bundle (P=0.009) and inferior cerebellar peduncle ( P=0.01). Lower ascending aorta Z scores were associated with higher radial diffusivity and mean diffusivity in a similar regional pattern but not with axial diffusivity. Conclusions In adolescents with single ventricle, smaller aorta diameter at birth is associated with abnormalities of WM microstructure in a subset of WM tracts, mostly those located in deeper brain regions. Our findings suggest that despite multiple intervening medical or surgical procedures, prenatal cerebral blood flow may have a lasting influence on WM microstructure in single-ventricle patients.
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Affiliation(s)
- Abbas H Zaidi
- 1 Department of Cardiology Boston Children's Hospital Boston MA.,5 Department of Pediatrics Harvard Medical School Boston MA
| | - Jane W Newburger
- 1 Department of Cardiology Boston Children's Hospital Boston MA.,5 Department of Pediatrics Harvard Medical School Boston MA
| | - David Wypij
- 1 Department of Cardiology Boston Children's Hospital Boston MA.,5 Department of Pediatrics Harvard Medical School Boston MA.,7 Department of Biostatistics Harvard T.H. Chan School of Public Health Boston MA
| | - Christian Stopp
- 1 Department of Cardiology Boston Children's Hospital Boston MA
| | | | - Kevin G Friedman
- 1 Department of Cardiology Boston Children's Hospital Boston MA.,5 Department of Pediatrics Harvard Medical School Boston MA
| | - Michael J Rivkin
- 2 Department of Neurology Boston Children's Hospital Boston MA.,3 Department of Psychiatry Boston Children's Hospital Boston MA.,4 Department of Radiology Boston Children's Hospital Boston MA.,6 Department of Neurology Harvard Medical School Boston MA
| | - Caitlin K Rollins
- 2 Department of Neurology Boston Children's Hospital Boston MA.,6 Department of Neurology Harvard Medical School Boston MA
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Howell HB, Zaccario M, Kazmi SH, Desai P, Sklamberg FE, Mally P. Neurodevelopmental outcomes of children with congenital heart disease: A review. Curr Probl Pediatr Adolesc Health Care 2019; 49:100685. [PMID: 31708366 DOI: 10.1016/j.cppeds.2019.100685] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.
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Affiliation(s)
- Heather B Howell
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Michele Zaccario
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA; Pace University, Department of Psychology, 41 Park Row, New York, NY 10038 USA
| | - Sadaf H Kazmi
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Purnahamsi Desai
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Felice E Sklamberg
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Pradeep Mally
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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Abstract
Pediatric clinicians are on the front line for prevention of language and speech disorders. This review uses prevailing theories and recent data to justify strategies for prevention, screening and detection, diagnosis, and treatment of language and speech disorders. Primary prevention rests on theories that language learning is an interaction between the child's learning capacities and the language environment. Language learning occurs in a social context with active child engagement. Theories support parent education and public programs that increase children's exposure to child-directed speech. Early detection of delays requires knowledge of language milestones and recognition of high-risk indicators for disorders. Male sex, bilingual environments, birth order, and chronic otitis media are not adequate explanations for significant delays in language or speech. Current guidelines recommend both general and autism-specific screening. Environmental and genetic factors contribute to primary language and speech disorders. Secondary and tertiary prevention requires early identification of children with language and speech disorders. Disorders may be found in association with chromosomal, genetic, neurologic, and other health conditions. Systematic reviews find that speech-language therapy, alone or in conjunction with other developmental services, is effective for many disorders. Speech-language interventions alter the environment and stimulate children's targeted responding to improve their skills.
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Affiliation(s)
- Heidi M Feldman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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34
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Postoperative brain volumes are associated with one-year neurodevelopmental outcome in children with severe congenital heart disease. Sci Rep 2019; 9:10885. [PMID: 31350426 PMCID: PMC6659678 DOI: 10.1038/s41598-019-47328-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 07/10/2019] [Indexed: 11/09/2022] Open
Abstract
Children with congenital heart disease (CHD) remain at risk for neurodevelopmental impairment despite improved perioperative care. Our prospective cohort study aimed to determine the relationship between perioperative brain volumes and neurodevelopmental outcome in neonates with severe CHD. Pre- and postoperative cerebral MRI was acquired in term born neonates with CHD undergoing neonatal cardiopulmonary bypass surgery. Brain volumes were measured using an atlas prior-based automated method. One-year neurodevelopmental outcome was assessed with the Bayley-III. CHD infants (n = 77) had lower pre- and postoperative total and regional brain volumes compared to controls (n = 44, all p < 0.01). CHD infants had poorer cognitive and motor outcome (p ≤ 0.0001) and a trend towards lower language composite score compared to controls (p = 0.06). Larger total and selected regional postoperative brain volumes were found to be associated with better cognitive and language outcomes (all p < 0.04) at one year. This association was independent of length of intensive care unit stay for total, cortical, temporal, frontal and cerebellar volumes. Therefore, reduced cerebral volume in CHD neonates undergoing bypass surgery may serve as a biomarker for impaired outcome.
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35
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Bragg J. Neurodevelopmental Outcomes in Children with Complex Congenital Heart Disease. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Lim JM, Porayette P, Marini D, Chau V, Au-Young SH, Saini A, Ly LG, Blaser S, Shroff M, Branson HM, Sananes R, Hickey EJ, Gaynor JW, Van Arsdell G, Miller SP, Seed M. Associations Between Age at Arterial Switch Operation, Brain Growth, and Development in Infants With Transposition of the Great Arteries. Circulation 2019; 139:2728-2738. [PMID: 31132861 DOI: 10.1161/circulationaha.118.037495] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Brain injury, impaired brain growth, and long-term neurodevelopmental problems are common in children with transposition of the great arteries. We sought to identify clinical risk factors for brain injury and poor brain growth in infants with transposition of the great arteries undergoing the arterial switch operation, and to examine their relationship with neurodevelopmental outcome. METHODS The brains of 45 infants with transposition of the great arteries undergoing surgical repair were imaged pre- and postoperatively using magnetic resonance imaging. Brain weight z scores were calculated based on brain volume and autopsy reference data. Brain injury scores were determined as previously described. Neurodevelopment was assessed at 18 months using the Bayley-III scores of infant development. The relationships between clinical variables, brain injury, perioperative brain growth, and 18-month Bayley-III scores were analyzed. RESULTS On preoperative imaging, moderate or severe white matter injury was present in 10 of 45 patients, whereas stroke was seen in 4 of 45. A similar prevalence of injury was seen on postoperative imaging, and we were unable to identify any clinical risk factors for brain injury. Brain weight z scores decreased perioperatively in 35 of 45 patients. The presence of a ventricular septal defect ( P=0.009) and older age at surgery ( P=0.007) were associated with impaired perioperative brain growth. When patients were divided into those undergoing surgery during the first 2 weeks of life (32/45) versus those being repaired later (13/45), infants repaired later had significantly worse perioperative brain growth (late repair postoperative brain weight z = -1.0±0.90 versus early repair z = -0.33±0.64; P=0.008). Bayley-III testing scores fell within the normal range for all patients, although age at repair ( P=0.03) and days of open chest ( P=0.03) were associated with a lower composite language score, and length of stay was associated with a lower composite cognitive score ( P=0.02). CONCLUSIONS Surgery beyond 2 weeks of age is associated with impaired brain growth and slower language development in infants with transposition of the great arteries cared for at our center. Although the mechanisms underlying this association are still unclear, extended periods of cyanosis and pulmonary overcirculation may adversely impact brain growth and subsequent neurodevelopment.
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Affiliation(s)
- Jessie Mei Lim
- Department of Physiology (J.M.L.), University of Toronto, Canada
| | - Prashob Porayette
- Division of Cardiology (P.O., D.M., A.S., M. Seed), The Hospital for Sick Children, Toronto, Canada
| | - Davide Marini
- Division of Cardiology (P.O., D.M., A.S., M. Seed), The Hospital for Sick Children, Toronto, Canada
| | - Vann Chau
- Division of Neurology (V.C., S.H.A.-Y., S.P.M.), The Hospital for Sick Children, Toronto, Canada.,Division of Neonatology (V.C., L.G.L.), The Hospital for Sick Children, Toronto, Canada
| | - Stephanie H Au-Young
- Division of Neurology (V.C., S.H.A.-Y., S.P.M.), The Hospital for Sick Children, Toronto, Canada.,Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada (S.H.A.-Y.)
| | - Amandeep Saini
- Division of Cardiology (P.O., D.M., A.S., M. Seed), The Hospital for Sick Children, Toronto, Canada
| | - Linh G Ly
- Division of Neonatology (V.C., L.G.L.), The Hospital for Sick Children, Toronto, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging (S.B., M. Shroff, H.M.B.), The Hospital for Sick Children, Toronto, Canada
| | - Manohar Shroff
- Department of Medical Imaging (M. Shroff), University of Toronto, Canada.,Department of Diagnostic Imaging (S.B., M. Shroff, H.M.B.), The Hospital for Sick Children, Toronto, Canada
| | - Helen M Branson
- Department of Diagnostic Imaging (S.B., M. Shroff, H.M.B.), The Hospital for Sick Children, Toronto, Canada
| | - Renee Sananes
- Department of Pediatrics (R.S., S.P.M., M. Seed), University of Toronto, Canada.,Labatt Family Heart Centre (R.S.), The Hospital for Sick Children, Toronto, Canada
| | - Edward J Hickey
- Division of Cardiovascular Surgery (E.J.H., G.V.A.), The Hospital for Sick Children, Toronto, Canada
| | - J William Gaynor
- Department of Surgery, Children's Hospital of Philadelphia, PA (J.W.G.)
| | - Glen Van Arsdell
- Division of Cardiovascular Surgery (E.J.H., G.V.A.), The Hospital for Sick Children, Toronto, Canada
| | - Steven P Miller
- Department of Pediatrics (R.S., S.P.M., M. Seed), University of Toronto, Canada.,Division of Neurology (V.C., S.H.A.-Y., S.P.M.), The Hospital for Sick Children, Toronto, Canada
| | - Mike Seed
- Department of Pediatrics (R.S., S.P.M., M. Seed), University of Toronto, Canada.,Division of Cardiology (P.O., D.M., A.S., M. Seed), The Hospital for Sick Children, Toronto, Canada
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Ortinau CM, Mangin-Heimos K, Moen J, Alexopoulos D, Inder TE, Gholipour A, Shimony JS, Eghtesady P, Schlaggar BL, Smyser CD. Prenatal to postnatal trajectory of brain growth in complex congenital heart disease. NEUROIMAGE-CLINICAL 2018; 20:913-922. [PMID: 30308377 PMCID: PMC6178192 DOI: 10.1016/j.nicl.2018.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/21/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Abstract
Altered brain development is a common feature of the neurological sequelae of complex congenital heart disease (CHD). These alterations include abnormalities in brain size and growth that begin prenatally and persist postnatally. However, the longitudinal trajectory of changes in brain volume from the prenatal to postnatal environment have not been investigated. We aimed to evaluate the trajectory of brain growth in a cohort of patients with complex CHD (n = 16) and healthy controls (n = 15) to test the hypothesis that patients with complex CHD would have smaller total brain volume (TBV) prenatally, which would become increasingly prominent by three months of age. Participants underwent fetal magnetic resonance imaging (MRI) at a mean of 32 weeks gestation, a preoperative/neonatal MRI shortly after birth, a postoperative MRI (CHD only), and a 3-month MRI to evaluate the trajectory of brain growth. Three-dimensional volumetric analysis was applied to the MRI data to measure TBV, as well as tissue-specific volumes of the cortical gray matter (CGM), white matter (WM), subcortical (deep nuclear) gray matter (SCGM), cerebellum, and cerebrospinal fluid (CSF). A random coefficients model was used to investigate longitudinal changes in TBV and demonstrated an altered trajectory of brain growth in the CHD population. The estimated slope for TBV from fetal to 3-month MRI was 11.5 cm3 per week for CHD infants compared to 16.7 cm3 per week for controls (p = 0.0002). Brain growth followed a similar trajectory for the CGM (p < 0.0001), SCGM (p = 0.002), and cerebellum (p = 0.005). There was no difference in growth of the WM (p = 0.30) or CSF (p = 0.085). Brain injury was associated with reduced TBV at 3-month MRI (p = 0.02). After removing infants with brain injury from the model, an altered trajectory of brain growth persisted in CHD infants (p = 0.006). These findings extend the existing literature by demonstrating longitudinal impairments in brain development in the CHD population and emphasize the global nature of disrupted brain growth from the prenatal environment through early infancy.
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Affiliation(s)
- Cynthia M Ortinau
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
| | - Kathryn Mangin-Heimos
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Joseph Moen
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ali Gholipour
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Bradley L Schlaggar
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA; Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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38
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Thomason ME, Hect J, Waller R, Manning JH, Stacks AM, Beeghly M, Boeve JL, Wong K, van den Heuvel MI, Hernandez-Andrade E, Hassan SS, Romero R. Prenatal neural origins of infant motor development: Associations between fetal brain and infant motor development. Dev Psychopathol 2018; 30:763-772. [PMID: 30068433 PMCID: PMC6261435 DOI: 10.1017/s095457941800072x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Functional circuits of the human brain emerge and change dramatically over the second half of gestation. It is possible that variation in neural functional system connectivity in utero predicts individual differences in infant behavioral development, but this possibility has yet to be examined. The current study examines the association between fetal sensorimotor brain system functional connectivity and infant postnatal motor ability. Resting-state functional connectivity data was obtained in 96 healthy human fetuses during the second and third trimesters of pregnancy. Infant motor ability was measured 7 months after birth using the Bayley Scales of Infant Development. Increased connectivity between the emerging motor network and regions of the prefrontal cortex, temporal lobes, posterior cingulate, and supplementary motor regions was observed in infants that showed more mature motor functions. In addition, females demonstrated stronger fetal-brain to infant-behavior associations. These observations extend prior longitudinal research back into prenatal brain development and raise exciting new ideas about the advent of risk and the ontogeny of early sex differences.
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Farr SL, Downing KF, Riehle-Colarusso T, Abarbanell G. Functional limitations and educational needs among children and adolescents with heart disease. CONGENIT HEART DIS 2018; 13:633-639. [PMID: 30033554 DOI: 10.1111/chd.12621] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/28/2018] [Accepted: 04/19/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine how cognitive and motor limitations in children with heart disease are associated with education and participation in extracurricular activities. DESIGN Using 2009-2010 parent-reported data from the National Survey of Children with Special Health Care Needs (NS-CSHCN), we examined prevalence of five functional limitations (learning/concentration, communication, self-care, gross motor skills, and fine motor skills) by diagnosed heart disease status using chi-square tests and multivariable logistic regression. Among CSHCN with heart disease, we examined the associations between severity of each functional limitation and missing ≥11 days of school in the past year, receiving special education services, and interference with extracurricular activities. RESULTS CSHCN with heart disease (n = 1,416), compared to CSHCN without (n = 28,385), more commonly had "a lot" of difficulty in the five functional areas (P < .01; adjusted odds ratios: 1.8-3.3). Among CSHCN with heart disease, "a lot" of difficulty with learning/concentration was most common (35%), followed by communication (21%), self-care (14%), gross motor skills (12%), and fine motor skills (10%). Among CSHCN with heart disease, compared to those without, respectively, 27% and 15% missed ≥11 days of school, 45% and 29% received special education services, and 49% and 29% experienced interference with extracurricular activities (P < .01 for all). Level of difficulty with the five functional areas was associated with receipt of special education services and participation in extracurricular activities (P < .001). CONCLUSION These results support the American Heart Association recommendations to screen children with congenital heart disease for age-appropriate development and provide services when needed.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Tiffany Riehle-Colarusso
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ginnie Abarbanell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri, USA
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D Chorna O, L Hamm E, Shrivastava H, Maitre NL. Feasibility of event-related potential (ERP) biomarker use to study effects of mother's voice exposure on speech sound differentiation of preterm infants. Dev Neuropsychol 2018; 43:123-134. [PMID: 29436854 DOI: 10.1080/87565641.2018.1433671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Atypical maturation of auditory neural processing contributes to preterm-born infants' language delays. Event-related potential (ERP) measurement of speech-sound differentiation might fill a gap in treatment-response biomarkers to auditory interventions. We evaluated whether these markers could measure treatment effects in a quasi-randomized prospective study. Hospitalized preterm infants in passive or active, suck-contingent mother's voice exposure groups were not different at baseline. Post-intervention, the active group had greater increases in/du/-/gu/differentiation in left frontal and temporal regions. Infants with brain injury had lower baseline/ba/-/ga/and/du/-/gu/differentiation than those without. ERP provides valid discriminative, responsive, and predictive biomarkers of infant speech-sound differentiation.
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Affiliation(s)
- Olena D Chorna
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA
| | - Ellyn L Hamm
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA
| | - Hemang Shrivastava
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA
| | - Nathalie L Maitre
- a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital , Columbus , OH , USA.,b Department of Hearing and Speech Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
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Peyvandi S, Latal B, Miller SP, McQuillen PS. The neonatal brain in critical congenital heart disease: Insights and future directions. Neuroimage 2018; 185:776-782. [PMID: 29787864 DOI: 10.1016/j.neuroimage.2018.05.045] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/18/2018] [Accepted: 05/18/2018] [Indexed: 12/17/2022] Open
Abstract
Neurodevelopmental outcomes are impaired in survivors of critical congenital heart disease (CHD) in several developmental domains including motor, cognitive and sensory outcomes. These deficits can extend into the adolescent and early adulthood years. The cause of these neurodevelopmental impairments is multi-factorial and includes patient specific risk factors, cardiac anatomy and physiology as well as brain changes seen on MRI. Advances in imaging techniques have identified delayed brain development in the neonate with critical CHD as well as acquired brain injury. These abnormalities are seen even before corrective neonatal cardiac surgery. This review focuses on describing brain changes seen on MRI in neonates with CHD, risk factors for these changes and the association with neurodevelopmental outcome. There is an emerging focus on the impact of cardiovascular physiology on brain health and the complex heart-brain interplay that influences ultimate neurodevelopmental outcome in these patients.
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Affiliation(s)
- Shabnam Peyvandi
- Division of Pediatric Cardiology, University of California San Francisco Benioff Children's Hospital, USA.
| | - Beatrice Latal
- University Children's Hospital Zurich, Child Development Center and Children's Research Center, Zurich, Switzerland
| | - Steven P Miller
- University of Toronto, Hospital for Sick Children, Department of Neurology, Canada
| | - Patrick S McQuillen
- Division of Critical Care, University of California San Francisco Benioff Children's Hospital, USA
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Ing RJ, Twite MD. Noteworthy Literature published in 2017 for Congenital Cardiac Anesthesiologists. Semin Cardiothorac Vasc Anesth 2018; 22:35-48. [DOI: 10.1177/1089253217753398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review focuses on the literature published during the 13 months from December 2016 to December 2017 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five themes are addressed during this time period and 100 peer-reviewed articles are discussed.
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Affiliation(s)
- Richard J. Ing
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado, Aurora, CO, USA
| | - Mark D. Twite
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado, Aurora, CO, USA
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Abstract
OBJECTIVES Determine the prevalence of intraventricular hemorrhage in infants with moderate to severe congenital heart disease, investigate the impact of gestational age, cardiac diagnosis, and cardiac intervention on intraventricular hemorrhage, and compare intraventricular hemorrhage rates in preterm infants with and without congenital heart disease. DESIGN A single-center retrospective review. SETTING A tertiary care children's hospital. PATIENTS All infants admitted to St. Louis Children's Hospital from 2007 to 2012 with moderate to severe congenital heart disease requiring cardiac intervention in the first 90 days of life and all preterm infants without congenital heart disease or congenital anomalies/known genetic diagnoses admitted during the same time period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cranial ultrasound data were reviewed for presence/severity of intraventricular hemorrhage. Head CT and brain MRI data were also reviewed in the congenital heart disease infants. Univariate analyses were undertaken to determine associations with intraventricular hemorrhage, and a final multivariate logistic regression model was performed. There were 339 infants with congenital heart disease who met inclusion criteria and 25.4% were born preterm. Intraventricular hemorrhage was identified on cranial ultrasound in 13.3% of infants, with the majority of intraventricular hemorrhage being low-grade (grade I/II). The incidence increased as gestational age decreased such that intraventricular hemorrhage was present in 8.7% of term infants, 19.2% of late preterm infants, 26.3% of moderately preterm infants, and 53.3% of very preterm infants. There was no difference in intraventricular hemorrhage rates between cardiac diagnoses. Additionally, the rate of intraventricular hemorrhage did not increase after cardiac intervention, with only three infants demonstrating new/worsening high-grade (grade III/IV) intraventricular hemorrhage after surgery. In a multivariate model, only gestational age at birth and African-American race were predictors of intraventricular hemorrhage. In the subset of infants with CT/MRI data, there was good sensitivity and specificity of cranial ultrasound for presence of intraventricular hemorrhage. CONCLUSIONS Infants with congenital heart disease commonly develop intraventricular hemorrhage, particularly when born preterm. However, the vast majority of intraventricular hemorrhage is low-grade and is associated with gestational age and African-American race.
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Cassidy AR, Ilardi D, Bowen SR, Hampton LE, Heinrich KP, Loman MM, Sanz JH, Wolfe KR. Congenital heart disease: A primer for the pediatric neuropsychologist. Child Neuropsychol 2017; 24:859-902. [DOI: 10.1080/09297049.2017.1373758] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Adam R. Cassidy
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dawn Ilardi
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Susan R. Bowen
- Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lyla E. Hampton
- Department of Child & Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Michelle M. Loman
- Departments of Neurology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacqueline H. Sanz
- Division of Neuropsychology, Children’s National Health System, Departments of Psychiatry and Behavioral Sciences & Pediatrics, George Washington University School of Medicine, , Washington, DC, USA
| | - Kelly R. Wolfe
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
OBJECTIVES Although evidence exists of broadly defined memory impairment among adolescents with critical congenital heart disease (CHD), nuanced investigations of declarative memory in this at-risk population have not been conducted. This study had two primary aims: (1) to conduct a fine-grained analysis of a range of relevant learning and memory processes in adolescents with critical biventricular CHD, and (2) to identify risk, odds, and predictors of memory impairment. METHODS Data were combined from two single-center studies of neurodevelopmental outcomes in critical CHD. Two-hundred seven adolescents (M age =15.61±1.0 years) with critical CHD (139 with dextro-transposition of the great arteries and 68 with tetralogy of Fallot without an identified genetic condition), as well as 61 healthy referents (M age =15.27±1.1 years) completed a neuropsychological evaluation which included the Children's Memory Scale. RESULTS Whereas visual-spatial memory deficits were found in both CHD subgroups, verbal memory abilities were relatively preserved. Adolescents with CHD demonstrated stronger memory for Stories than Word Pairs, t (203)=2.63, p=.009, and for Dot Locations than Faces, t(204)=-2.57, p=.01. CHD subgroup, socioeconomic status, sex, and seizure history were among the most frequent significant predictors of memory impairment. Seizure history, in particular, was associated with a 2 to 3 times greater odds of impaired performance on learning and memory tasks. CONCLUSIONS Adolescents with critical biventricular CHD are at risk for deficits in aspects of declarative memory. Independent risk factors for worse outcome include history of seizures. (JINS, 2017, 23, 627-639).
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Abstract
This article is a review of the literature published during the 12 months of 2016 that are of interest to the congenital cardiac anesthesiologist. Five themes are addressed for 2016, and 53 peer-reviewed articles are discussed.
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Affiliation(s)
- Richard J. Ing
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark Twite
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
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