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Kim JH, Kapse K, Limperopoulos C, De Asis-Cruz J. Cerebellar volume and functional connectivity in neonates predicts social and emotional development in toddlers. Front Neurosci 2024; 18:1294527. [PMID: 38756409 PMCID: PMC11097671 DOI: 10.3389/fnins.2024.1294527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Over the past decade, a growing body of research in adults has emphasized the role of the cerebellum in social and emotional cognition. This has been further supported by findings of delayed social and emotional development in toddlers with cerebellar injury during the fetal and newborn periods. However, the contributions of the cerebellum to social-emotional development in typically developing newborns are unclear. To bridge this gap in knowledge, we used multimodal MRI to investigate associations between cerebellar structure and function in 88 healthy neonates (mean ± sd of postmenstrual age, = 42.00 ± 1.91 weeks) and social-emotional development at 18-months assessed using the Infant-Toddler Social-Emotional Assessment (ITSEA) (mean age on ITSEA: 18.32 ± 1.19 months old). We found that cerebellar volume was not associated with ITSEA domain scores at 18 months. We further demonstrated cerebellar functional gradient (FGR) defined using principal component analysis (PCA) was associated with Externalizing domain (linear regression model, false-discovery-rate-adjusted p = 0.013). This cluster (FGR7) included the left dentate, right VI, left Vermis VIIIb, and right V lobules. Finally, we demonstrated that either structural or functional features of the cerebellum reliably predicted scores on the Externalizing and Internalizing domains (correlation between actual and predicted scores: for structural, Fisher's z = 0.48 ± 0.01 for Internalizing, p = 0.01; for functional, Fisher's z = 0.45 ± 0.01 for Externalizing, p = 0.02; with permutation test). Collectively, our findings suggest that the cerebellum plays an important role in social-emotional development during the critical early stages of life.
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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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Christoffel K, De Asis-Cruz J, Govindan RB, Kim JH, Cook KM, Kapse K, Andescavage N, Basu S, Spoehr E, Limperopoulos C, Du Plessis A. Central Autonomic Network and heart rate variability in premature neonates. Dev Neurosci 2024:000536513. [PMID: 38320522 DOI: 10.1159/000536513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION The Central Autonomic Network (CAN) is a hierarchy of brain structures that collectively influence cardiac autonomic input, mediating the majority of brain-heart interactions, but has never been studied in premature neonates. In this study, we use heart rate variability (HRV), which has been described as the "primary output" of the CAN, and resting state functional MRI to characterize brain-heart relationships in premature neonates. METHODS We studied premature neonates who underwent resting state functional MRI (rsfMRI) at term, (37-weeks postmenstrual age [PMA] or above) and had HRV data recorded during the same week of their MRI. HRV was derived from continuous electrocardiogram data during the week of the rsfMRI scan. For rsfMRI, a seed-based approach was used to define regions of interest (ROI) pertinent to the CAN, and blood oxygen level-dependent signal was correlated between each ROI as a measure of functional connectivity. HRV was correlated with CAN connectivity (CANconn) for each region, and sub-group analysis was performed based on sex and clinical comorbidities. RESULTS Forty-seven premature neonates were included in this study, with a mean gestational age at birth of 28.1 +/- 2.6 weeks. Term CANconn was found to be significantly correlated with HRV in approximately one-fifth of CAN connections. Two distinct patterns emerged among these HRV-CANconn relationships. In the first, increased HRV was associated with stronger CANconn of limbic regions. In the second pattern, stronger CANconn at the precuneus was associated with impaired HRV maturation. These patterns were especially pronounced in male premature neonates. CONCLUSION We report for the first time evidence of brain-heart relationships in premature neonates and an emerging CAN, most striking in male neonates, suggesting that the brain-heart axis may be more vulnerable in male premature neonates. Signatures in the heart rate may eventually become an important non-invasive tool to identify premature males at highest risk for neurodevelopmental impairment.
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Shimamoto Y, Fukushima K, Mizuno T, Ichikawa H, Kurosaki K, Maeda S, Okuda M. Model-Informed Vancomycin Dosing Optimization to Address Delayed Renal Maturation in Infants and Young Children with Critical Congenital Heart Disease. Clin Pharmacol Ther 2024; 115:239-247. [PMID: 37994537 DOI: 10.1002/cpt.3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/29/2023] [Indexed: 11/24/2023]
Abstract
Ensuring safe and effective drug therapy in infants and young children often requires accounting for growth and organ development; however, data on organ function maturation are scarce for special populations, such as infants with congenital diseases. Children with critical congenital heart disease (CCHD) often require multiple staged surgeries depending on their age and disease severity. Vancomycin (VCM) is used to treat postoperative infections; however, the standard pediatric dose (60-80 mg/kg/day) frequently results in overexposure in children with CCHD. In this study, we characterized the maturation of VCM clearance in pediatric patients with CCHD and determined the appropriate dosing regimen using population pharmacokinetic (PK) modeling and simulations. We analyzed 1,254 VCM serum concentrations from 152 postoperative patients (3 days-13 years old) for population PK analysis. The PK model was developed using a two-compartment model with allometrically scaled body weight, estimated glomerular filtration rate (eGFR), and postmenstrual age as covariates. The observed clearance in patients aged ≤ 1 year and 1-2 years was 33% and 40% lower compared with that of non-CCHD patients, respectively, indicating delayed renal maturation in patients with CCHD. Simulation analyses suggested VCM doses of 25 mg/kg/day (age ≤ 3 months, eGFR 40 mL/min/1.73 m2 ) and 35 mg/kg/day (3 months < age ≤ 3 years, eGFR 60 mL/min/1.73 m2 ). In conclusion, this study revealed delayed renal maturation in children with CCHD, could be due to cyanosis and low cardiac output. Model-informed simulations identified the lower VCM doses for children with CCHD compared with standard pediatric guidelines.
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Affiliation(s)
- Yuko Shimamoto
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Hospital Pharmacy, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keizo Fukushima
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tomoyuki Mizuno
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shinichiro Maeda
- Center for Advanced Education and Research in Pharmaceutical Sciences Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Masahiro Okuda
- Department of Hospital Pharmacy, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Maleyeff L, Newburger JW, Wypij D, Thomas NH, Anagnoustou E, Brueckner M, Chung WK, Cleveland J, Cunningham S, Gelb BD, Goldmuntz E, Hagler DJ, Huang H, King E, McQuillen P, Miller TA, Norris‐Brilliant A, Porter GA, Roberts AE, Grant PE, Im K, Morton SU. Association of genetic and sulcal traits with executive function in congenital heart disease. Ann Clin Transl Neurol 2024; 11:278-290. [PMID: 38009418 PMCID: PMC10863927 DOI: 10.1002/acn3.51950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Persons with congenital heart disease (CHD) are at increased risk of neurodevelopmental disabilities, including impairments to executive function. Sulcal pattern features correlate with executive function in adolescents with single-ventricle heart disease and tetralogy of Fallot. However, the interaction of sulcal pattern features with genetic and participant factors in predicting executive dysfunction is unknown. METHODS We studied sulcal pattern features, participant factors, and genetic risk for executive function impairment in a cohort with multiple CHD types using stepwise linear regression and machine learning. RESULTS Genetic factors, including predicted damaging de novo or rare inherited variants in neurodevelopmental disabilities risk genes, apolipoprotein E genotype, and principal components of sulcal pattern features were associated with executive function measures after adjusting for age at testing, sex, mother's education, and biventricular versus single-ventricle CHD in a linear regression model. Using regression trees and bootstrap validation, younger participant age and larger alterations in sulcal pattern features were consistently identified as important predictors of decreased cognitive flexibility with left hemisphere graph topology often selected as the most important predictor. Inclusion of both sulcal pattern and genetic factors improved model fit compared to either alone. INTERPRETATION We conclude that sulcal measures remain important predictors of cognitive flexibility, and the model predicting executive outcomes is improved by inclusion of potential genetic sources of neurodevelopmental risk. If confirmed, measures of sulcal patterning may serve as early imaging biomarkers to identify those at heightened risk for future neurodevelopmental disabilities.
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Affiliation(s)
- Lara Maleyeff
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jane W. Newburger
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
| | - David Wypij
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
| | - Nina H. Thomas
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and Center for Human Phenomic ScienceChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Evdokia Anagnoustou
- Department of PediatricsHolland Bloorview Kids Rehabilitation Hospital, University of TorontoTorontoOntarioCanada
| | - Martina Brueckner
- Department of GeneticsYale University School of MedicineNew HavenConnecticutUSA
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Wendy K. Chung
- Department of PediatricsColumbia University Medical CenterNew YorkNew YorkUSA
- Department of MedicineColumbia University Medical CenterNew YorkNew YorkUSA
| | - John Cleveland
- Department of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sean Cunningham
- Division of General Pediatrics, Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of PediatricsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of PediatricsChildren's Hospital of Philadelphia, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Donald J Hagler
- Center for Multimodal Imaging and GeneticsUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of Radiology, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Hao Huang
- Department of RadiologyChildren's Hospital of Philadelphia, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Eileen King
- Department of PediatricsUniversity of CincinnatiCincinnatiOhioUSA
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Patrick McQuillen
- Department of PediatricsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Thomas A. Miller
- Department of PediatricsPrimary Children's Hospital, University of UtahSalt Lake CityUtahUSA
- Division of Pediatric CardiologyMaine Medical CenterPortlandMaineUSA
| | - Ami Norris‐Brilliant
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - George A. Porter
- Department of PediatricsUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Amy E. Roberts
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyBoston Children's HospitalBostonMassachusettsUSA
- Division of Genetics and GenomicsBoston Children's HospitalBostonMassachusettsUSA
| | - P. Ellen Grant
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Division of Newborn Medicine, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
- Department of RadiologyBoston Children's HospitalBostonMassachusettsUSA
| | - Kiho Im
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Division of Newborn Medicine, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
| | - Sarah U. Morton
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Division of Newborn Medicine, Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
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O’Brien MP, Pryzhkova MV, Lake EMR, Mandino F, Shen X, Karnik R, Atkins A, Xu MJ, Ji W, Konstantino M, Brueckner M, Ment LR, Khokha MK, Jordan PW. SMC5 Plays Independent Roles in Congenital Heart Disease and Neurodevelopmental Disability. Int J Mol Sci 2023; 25:430. [PMID: 38203602 PMCID: PMC10779392 DOI: 10.3390/ijms25010430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Up to 50% of patients with severe congenital heart disease (CHD) develop life-altering neurodevelopmental disability (NDD). It has been presumed that NDD arises in CHD cases because of hypoxia before, during, or after cardiac surgery. Recent studies detected an enrichment in de novo mutations in CHD and NDD, as well as significant overlap between CHD and NDD candidate genes. However, there is limited evidence demonstrating that genes causing CHD can produce NDD independent of hypoxia. A patient with hypoplastic left heart syndrome and gross motor delay presented with a de novo mutation in SMC5. Modeling mutation of smc5 in Xenopus tropicalis embryos resulted in reduced heart size, decreased brain length, and disrupted pax6 patterning. To evaluate the cardiac development, we induced the conditional knockout (cKO) of Smc5 in mouse cardiomyocytes, which led to the depletion of mature cardiomyocytes and abnormal contractility. To test a role for Smc5 specifically in the brain, we induced cKO in the mouse central nervous system, which resulted in decreased brain volume, and diminished connectivity between areas related to motor function but did not affect vascular or brain ventricular volume. We propose that genetic factors, rather than hypoxia alone, can contribute when NDD and CHD cases occur concurrently.
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Affiliation(s)
- Matthew P. O’Brien
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Marina V. Pryzhkova
- Biochemistry and Molecular Biology Department, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
- Department of Biochemistry and Molecular Biology, Uniformed Services, University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
| | - Evelyn M. R. Lake
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Francesca Mandino
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Xilin Shen
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Ruchika Karnik
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Alisa Atkins
- Biochemistry and Molecular Biology Department, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Michelle J. Xu
- Biochemistry and Molecular Biology Department, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Weizhen Ji
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Pediatric Genomics Discovery Program, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Monica Konstantino
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Pediatric Genomics Discovery Program, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Martina Brueckner
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Department of Genetics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Laura R. Ment
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Mustafa K. Khokha
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Pediatric Genomics Discovery Program, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
- Department of Genetics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Philip W. Jordan
- Biochemistry and Molecular Biology Department, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
- Department of Biochemistry and Molecular Biology, Uniformed Services, University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
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Cook KM, De Asis-Cruz J, Kim JH, Basu SK, Andescavage N, Murnick J, Spoehr E, Liggett M, du Plessis AJ, Limperopoulos C. Experience of early-life pain in premature infants is associated with atypical cerebellar development and later neurodevelopmental deficits. BMC Med 2023; 21:435. [PMID: 37957651 PMCID: PMC10644599 DOI: 10.1186/s12916-023-03141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Infants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to earlier-than-typical exposure to the extrauterine environment, and its bright lights, loud noises, and exposures to painful procedures. Given the relative underdeveloped pain modulatory responses in these infants, frequent pain exposures may confer risk for later deficits. METHODS Resting-state fMRI scans were collected at term equivalent age from 148 (45% male) infants born V/EPT and 99 infants (56% male) born at term age. Functional connectivity analyses were performed between functional regions correlating connectivity to the number of painful skin break procedures in the NICU, including heel lances, venipunctures, and IV placements. Subsequently, preterm infants returned at 18 months, for neurodevelopmental follow-up and completed assessments for autism risk and general neurodevelopment. RESULTS We observed that V/EPT infants exhibit pronounced hyperconnectivity within the cerebellum and between the cerebellum and both limbic and paralimbic regions correlating with the number of skin break procedures. Moreover, skin breaks were strongly associated with autism risk, motor, and language scores at 18 months. Subsample analyses revealed that the same cerebellar connections strongly correlating with breaks at term age were associated with language dysfunction at 18 months. CONCLUSIONS These results have significant implications for the clinical care of preterm infants undergoing painful exposures during routine NICU care, which typically occurs without anesthesia. Repeated pain exposures appear to have an increasingly detrimental effect on brain development during a critical period, and effects continue to be seen even 18 months later.
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Affiliation(s)
- Kevin M Cook
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jung-Hoon Kim
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Sudeepta K Basu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jonathan Murnick
- Dept. of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, D.C, 20010, USA
| | - Emma Spoehr
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Melissa Liggett
- Division of Psychology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adré J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
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De Asis-Cruz J, Andescavage N, Donofrio MT, Vezina G, Wessel D, du Plessis A, Limperopoulos C. Disrupted Functional Brain Connectome in the Fetus With Congenital Heart Disease. Circ Res 2023; 133:959-961. [PMID: 37823309 PMCID: PMC10841392 DOI: 10.1161/circresaha.123.323276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
| | - Nickie Andescavage
- Developing Brain Institute (J.D.A.-C., N.A., C.L.), Children's National, Washington, DC
- Division of Neonatology (N.A.), Children's National, Washington, DC
| | - Mary T Donofrio
- Department of Cardiology (M.T.D.), Children's National, Washington, DC
| | - Gilbert Vezina
- Department of Diagnostic Imaging and Radiology (G.V.), Children's National, Washington, DC
| | - David Wessel
- Chief Medical Officer (D.W.), Children's National, Washington, DC
| | - Adre du Plessis
- Prenatal Pediatrics Institute (A.d.P., C.L.), Children's National, Washington, DC
| | - Catherine Limperopoulos
- Developing Brain Institute (J.D.A.-C., N.A., C.L.), Children's National, Washington, DC
- Prenatal Pediatrics Institute (A.d.P., C.L.), Children's National, Washington, DC
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9
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Provost S, Fourdain S, Vannasing P, Tremblay J, Roger K, García-Puente Y, Doussau A, Vinay MC, Von Siebenthal Z, Paquette N, Poirier N, Gallagher A. Relationship between 4-month functional brain network topology and 24-month neurodevelopmental outcome in children with congenital heart disease. Eur J Paediatr Neurol 2023; 47:47-59. [PMID: 37729706 DOI: 10.1016/j.ejpn.2023.09.005] [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] [Received: 11/10/2022] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Survivors of complex forms of congenital heart disease (CHD)∗ are at high risk of neurodevelopmental disabilities. Neuroimaging studies have pointed to brain anomalies and immature networks in infants with CHD, yet less is known about their functional network topology and associations with neurodevelopment. To characterize the functional network topology in 4-month-old infants with repaired CHD, we compared graph theory metrics measured using resting-state functional near-infrared spectroscopy (rs-fNIRS) between infants with CHD (n = 22) and healthy controls (n = 30). We also investigated the moderating effect of graph theory metrics on the relationship between group (CHD vs. Controls) and developmental outcomes at 24 months. At 4 months, both groups presented similar functional brain network topology. At 24 months, children with CHD had lower scores on the language scale and the expressive communication subscale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), as well as lower scores on the Grammatical Form scale of the MacArthur-Bates Communicative Development Inventory (MBCDI). The relationship between group and expressive language was moderated by the normalized characteristic path length (λ) and the degree (k). Although infants with CHD have functional brain topology similar to that of healthy controls, our findings suggest that they do not benefit from an optimal functional brain organization in comparison with healthy infants.
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Affiliation(s)
- Sarah Provost
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Solène Fourdain
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Phetsamone Vannasing
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Julie Tremblay
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Kassandra Roger
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | | | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Zorina Von Siebenthal
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Natacha Paquette
- Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Nancy Poirier
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Anne Gallagher
- Department of Psychology, Université de Montréal, Montreal, QC, Canada; Neurodevelopmental Optical Imaging Lab (LIONlab), Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.
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10
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Fourdain S, Provost S, Tremblay J, Vannasing P, Doussau A, Caron-Desrochers L, Gaudet I, Roger K, Hüsser A, Dehaes M, Martinez-Montes E, Poirier N, Gallagher A. Functional brain connectivity after corrective cardiac surgery for critical congenital heart disease: a preliminary near-infrared spectroscopy (NIRS) report. Child Neuropsychol 2023; 29:1088-1108. [PMID: 36718095 DOI: 10.1080/09297049.2023.2170340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/13/2023] [Indexed: 02/01/2023]
Abstract
Patients with congenital heart disease (CHD) requiring cardiac surgery in infancy are at high risk for neurodevelopmental impairments. Neonatal imaging studies have reported disruptions of brain functional organization before surgery. Yet, the extent to which functional network alterations are present after cardiac repair remains unexplored. This preliminary study aimed at investigating cortical functional connectivity in 4-month-old infants with repaired CHD, using resting-state functional near-infrared spectroscopy (fNIRS). After fNIRS signal frequency decomposition, we compared values of magnitude-squared coherence as a measure of connectivity strength, between 21 infants with corrected CHD and 31 healthy controls. We identified a subset of connections with differences between groups at an uncorrected statistical level of p < .05 while controlling for sex and maternal socioeconomic status, with most of these connections showing reduced connectivity in infants with CHD. Although none of these differences reach statistical significance after FDR correction, likely due to the small sample size, moderate to large effect sizes were found for group-differences. If replicated, these results would therefore suggest preliminary evidence that alterations of brain functional connectivity are present in the months after cardiac surgery. Additional studies involving larger sample size are needed to replicate our data, and comparisons between pre- and postoperative findings would allow to further delineate alterations of functional brain connectivity in this population.
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Affiliation(s)
- Solène Fourdain
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Sarah Provost
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Julie Tremblay
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | | | - Amélie Doussau
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine, Montreal University Hospital Center, Montreal, QC, Canada
| | - Laura Caron-Desrochers
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Isabelle Gaudet
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Kassandra Roger
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Alejandra Hüsser
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
| | - Mathieu Dehaes
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Nancy Poirier
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine, Montreal University Hospital Center, Montreal, QC, Canada
- Department of Surgery, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
| | - Anne Gallagher
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada
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11
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Cook KM, De Asis-Cruz J, Basu SK, Andescavage N, Murnick J, Spoehr E, du Plessis AJ, Limperopoulos C. Ex-utero third trimester developmental changes in functional brain network organization in infants born very and extremely preterm. Front Neurosci 2023; 17:1214080. [PMID: 37719160 PMCID: PMC10502339 DOI: 10.3389/fnins.2023.1214080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The latter half of gestation is a period of rapid brain development, including the formation of fundamental functional brain network architecture. Unlike in-utero fetuses, infants born very and extremely preterm undergo these critical maturational changes in the extrauterine environment, with growing evidence suggesting this may result in altered brain networks. To date, however, the development of functional brain architecture has been unexplored. Methods From a prospective cohort of preterm infants, graph parameters were calculated for fMRI scans acquired prior to reaching term equivalent age. Eight graph properties were calculated, Clustering Coefficient (C), Characteristic Path Length (L), Modularity (Q), Local Efficiency (LE), Global Efficiency (GE), Normalized Clustering (λ), Normalized Path Length (γ), and Small-Worldness (σ). Properties were first compared to values generated from random and lattice networks and cost efficiency was evaluated. Subsequently, linear mixed effect models were used to assess relationship with postmenstrual age and infant sex. Results A total of 111 fMRI scans were acquired from 85 preterm infants born at a mean GA 28.93 ± 2.8. Infants displayed robust small world properties as well as both locally and globally efficient networks. Regression models found that GE increased while L, Q, λ, γ, and σ decreased with increasing postmenstrual age following multiple comparison correction (r2Adj range 0.143-0.401, p < 0048), with C and LE exhibited trending increases with age. Discussion This is the first direct investigation on the extra-uterine formation of functional brain architecture in preterm infants. Importantly, our results suggest that changes in functional architecture with increasing age exhibit a different trajectory relative to in utero fetus. Instead, they exhibit developmental changes more similar to the early postnatal period in term born infants.
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Affiliation(s)
- Kevin M. Cook
- Developing Brain Institute, Children’s National Hospital, Washington, DC, United States
| | | | - Sudeepta K. Basu
- Developing Brain Institute, Children’s National Hospital, Washington, DC, United States
| | - Nickie Andescavage
- Developing Brain Institute, Children’s National Hospital, Washington, DC, United States
| | - Jonathan Murnick
- Department of Diagnostic Imaging & Radiology, Children’s National Health System, Children’s National Hospital, Washington, DC, United States
| | - Emma Spoehr
- Developing Brain Institute, Children’s National Hospital, Washington, DC, United States
| | - Adré J. du Plessis
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC, United States
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12
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Kim J, De Asis‐Cruz J, Kapse K, Limperopoulos C. Systematic evaluation of head motion on resting-state functional connectivity MRI in the neonate. Hum Brain Mapp 2023; 44:1934-1948. [PMID: 36576333 PMCID: PMC9980896 DOI: 10.1002/hbm.26183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/29/2022] Open
Abstract
Reliability and robustness of resting state functional connectivity MRI (rs-fcMRI) relies, in part, on minimizing the influence of head motion on measured brain signals. The confounding effects of head motion on functional connectivity have been extensively studied in adults, but its impact on newborn brain connectivity remains unexplored. Here, using a large newborn data set consisting of 159 rs-fcMRI scans acquired in the Developing Brain Institute at Children's National Hospital and 416 scans from The Developing Human Connectome Project (dHCP), we systematically investigated associations between head motion and rs-fcMRI. Head motion during the scan significantly affected connectivity at sensory-related networks and default mode networks, and at the whole brain scale; the direction of motion effects varied across the whole brain. Comparing high- versus low-head motion groups suggested that head motion can impact connectivity estimates across the whole brain. Censoring of high-motion volumes using frame-wise displacement significantly reduced the confounding effects of head motion on neonatal rs-fcMRI. Lastly, in the dHCP data set, we demonstrated similar persistent associations between head motion and network connectivity despite implementing a standard denoising strategy. Collectively, our results highlight the importance of using rigorous head motion correction in preprocessing neonatal rs-fcMRI to yield reliable estimates of brain activity.
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Affiliation(s)
- Jung‐Hoon Kim
- Developing Brain Institute, Children's NationalWashingtonDistrict of ColumbiaUSA
| | | | - Kushal Kapse
- Developing Brain Institute, Children's NationalWashingtonDistrict of ColumbiaUSA
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13
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Chirumamilla VC, Hitchings L, Mulkey SB, Anwar T, Baker R, Larry Maxwell G, De Asis-Cruz J, Kapse K, Limperopoulos C, du Plessis A, Govindan RB. Functional brain network properties of healthy full-term newborns quantified by scalp and source-reconstructed EEG. Clin Neurophysiol 2023; 147:72-80. [PMID: 36731349 PMCID: PMC9975070 DOI: 10.1016/j.clinph.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Identifying the functional brain network properties of term low-risk newborns using high-density EEG (HD-EEG) and comparing these properties with those of established functional magnetic resonance image (fMRI) - based networks. METHODS HD-EEG was collected from 113 low-risk term newborns before delivery hospital discharge and within 72 hours of birth. Functional brain networks were reconstructed using coherence at the scalp and source levels in delta, theta, alpha, beta, and gamma frequency bands. These networks were characterized for the global and local network architecture. RESULTS Source-level networks in all the frequency bands identified the presence of the efficient small world (small-world propensity (SWP) > 0.6) architecture with four distinct modules linked by hub regions and rich-club (coefficient > 1) topology. The modular regions included primary, association, limbic, paralimbic, and subcortical regions, which have been demonstrated in fMRI studies. In contrast, scalp-level networks did not display consistent small world architecture (SWP < 0.6), and also identified only 2-3 modules in each frequency band.The modular regions of the scalp-network primarily included frontal and occipital regions. CONCLUSIONS Our findings show that EEG sources in low-risk newborns corroborate fMRI-based connectivity results. SIGNIFICANCE EEG source analysis characterizes functional connectivity at the bedside of low-risk newborn infants soon after birth.
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Affiliation(s)
| | - Laura Hitchings
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
| | - Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Tayyba Anwar
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Robin Baker
- Inova Women's and Children's Hospital, Fairfax, VA, USA; Fairfax Neonatal Associates, Fairfax, VA, USA
| | | | | | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, USA
| | - Adre du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - R B Govindan
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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14
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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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15
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Structural Racism, Social Determinants of Health, and Provider Bias: Impact on Brain Development in Critical Congenital Heart Disease. Can J Cardiol 2023; 39:133-143. [PMID: 36368561 DOI: 10.1016/j.cjca.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Critical congenital heart disease (cCHD) has neurodevelopmental sequelae that can carry into adulthood, which may be due to aberrant brain development or brain injury in the prenatal and perinatal/neonatal periods and beyond. Health disparities based on the intersection of sex, geography, race, and ethnicity have been identified for poorer pre- and postnatal outcomes in the general population, as well as those with cCHD. These disparities are likely driven by structural racism, disparities in social determinants of health, and provider bias, which further compound negative brain development outcomes. This review discusses how aberrant brain development in cCHD early in life is affected by reduced access to quality care (ie, prenatal care and testing, postnatal care) due to divestment in non-White neighbourhoods (eg, redlining) and food insecurity, differences in insurance status, location of residence, and perceived interpersonal racism and bias that disproportionately affects pregnant people of colour who have fewer economic resources. Suggestions are discussed for moving forward with implementing strategies in medical education, clinical care, research, and gaining insight into the communities served to combat disparities and bias while promoting cultural humility.
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16
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Williamson BJ, Barnes-Davis ME, Vannest J, Anixt JS, Heydarian HC, Kuan L, Laue CS, Pratap J, Schapiro M, Tseng SY, Kadis DS. Altered white matter connectivity in children with congenital heart disease with single ventricle physiology. Sci Rep 2023; 13:1318. [PMID: 36693986 PMCID: PMC9873737 DOI: 10.1038/s41598-023-28634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Children born with congenital heart disease (CHD) have seen a dramatic decrease in mortality thanks to surgical innovations. However, there are numerous risk factors associated with CHD that can disrupt neurodevelopment. Recent studies have found that psychological deficits and structural brain abnormalities persist into adulthood. The goal of the current study was to investigate white matter connectivity in early school-age children (6-11 years), born with complex cyanotic CHD (single ventricle physiology), who have undergone Fontan palliation, compared to a group of heart-healthy, typically developing controls (TPC). Additionally, we investigated associations between white matter tract connectivity and measures on a comprehensive neuropsychological battery within each group. Our results suggest CHD patients exhibit widespread decreases in white matter connectivity, and the extent of these decreases is related to performance in several cognitive domains. Analysis of network topology showed that hub distribution was more extensive and bilateral in the TPC group. Our results are consistent with previous studies suggesting perinatal ischemia leads to white matter lesions and delayed maturation.
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Affiliation(s)
| | - Maria E Barnes-Davis
- Department of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Julia S Anixt
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Haleh C Heydarian
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa Kuan
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cameron S Laue
- Department Psychology, Pacific University, Forest Grove, OR, USA
| | - Jayant Pratap
- Divisions of Cardiac Anesthesia and Cardiac Critical Care Medicine, Department of Anesthesia and Critical Care Medicine and Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Schapiro
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Darren S Kadis
- Neurosciences and Mental Health, Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Department of Physiology, University of Toronto, Toronto, ON, Canada.
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17
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Votava-Smith JK, Gaesser J, Harbison AL, Lee V, Tran N, Rajagopalan V, del Castillo S, Kumar SR, Herrup E, Baust T, Johnson JA, Gabriel GC, Reynolds WT, Wallace J, Meyers B, Ceschin R, Lo CW, Schmithorst VJ, Panigrahy A. Clinical factors associated with microstructural connectome related brain dysmaturation in term neonates with congenital heart disease. Front Neurosci 2022; 16:952355. [PMID: 36466162 PMCID: PMC9717392 DOI: 10.3389/fnins.2022.952355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Term congenital heart disease (CHD) neonates display abnormalities of brain structure and maturation, which are possibly related to underlying patient factors, abnormal physiology and perioperative insults. Our primary goal was to delineate associations between clinical factors and postnatal brain microstructure in term CHD neonates using diffusion tensor imaging (DTI) magnetic resonance (MR) acquisition combined with complementary data-driven connectome and seed-based tractography quantitative analyses. Our secondary goal was to delineate associations between mild dysplastic structural brain abnormalities and connectome and seed-base tractography quantitative analyses. These mild dysplastic structural abnormalities have been derived from prior human infant CHD MR studies and neonatal mouse models of CHD that were collectively used to calculate to calculate a brain dysplasia score (BDS) that included assessment of subcortical structures including the olfactory bulb, the cerebellum and the hippocampus. Methods Neonates undergoing cardiac surgery for CHD were prospectively recruited from two large centers. Both pre- and postoperative MR brain scans were obtained. DTI in 42 directions was segmented into 90 regions using a neonatal brain template and three weighted methods. Clinical data collection included 18 patient-specific and 9 preoperative variables associated with preoperative scan and 6 intraoperative (e.g., cardiopulmonary bypass and deep hypothermic circulatory arrest times) and 12 postoperative variables associated with postoperative scan. We compared patient specific and preoperative clinical factors to network topology and tractography alterations on a preoperative neonatal brain MRI, and intra and postoperative clinical factors to network topology alterations on postoperative neonatal brain MRI. A composite BDS was created to score abnormal findings involving the cerebellar hemispheres and vermis, supratentorial extra-axial fluid, olfactory bulbs and sulci, hippocampus, choroid plexus, corpus callosum, and brainstem. The neuroimaging outcomes of this study included (1) connectome metrics: cost (number of connections) and global/nodal efficiency (network integration); (2) seed based tractography methods of fractional anisotropy (FA), radial diffusivity, and axial diffusivity. Statistics consisted of multiple regression with false discovery rate correction (FDR) comparing the clinical risk factors and BDS (including subcortical components) as predictors/exposures and the global connectome metrics, nodal efficiency, and seed based- tractography (FA, radial diffusivity, and axial diffusivity) as neuroimaging outcome measures. Results A total of 133 term neonates with complex CHD were prospectively enrolled and 110 had analyzable DTI. Multiple patient-specific factors including d-transposition of the great arteries (d-TGA) physiology and severity of impairment of fetal cerebral substrate delivery (i.e., how much the CHD lesion alters typical fetal circulation such that the highest oxygen and nutrient rich blood from the placenta are not directed toward the fetal brain) were predictive of preoperative reduced cost (p < 0.0073) and reduced global/nodal efficiency (p < 0.03). Cardiopulmonary bypass time predicted postoperative reduced cost (p < 0.04) and multiple postoperative factors [extracorporeal membrane oxygenation (ECMO), seizures and cardiopulmonary resuscitation (CPR)] were predictive of postoperative reduced cost and reduced global/nodal efficiency (p < 0.05). Anthropometric measurements (weight, length, and head size) predicted tractography outcomes. Total BDS was not predictive of brain network topology. However, key subcortical components of the BDS score did predict key global and nodal network topology: abnormalities of the cerebellum predicted reduced cost (p < 0.0417) and of the hippocampus predicted reduced global efficiency (p < 0.0126). All three subcortical structures predicted unique alterations of nodal efficiency (p < 0.05), including hippocampal abnormalities predicting widespread reduced nodal efficiency in all lobes of the brain, cerebellar abnormalities predicting increased prefrontal nodal efficiency, and olfactory bulb abnormalities predicting posterior parietal-occipital nodal efficiency. Conclusion Patient-specific (d-TGA anatomy, preoperative impairment of fetal cerebral substrate delivery) and postoperative (e.g., seizures, need for ECMO, or CPR) clinical factors were most predictive of diffuse postnatal microstructural dysmaturation in term CHD neonates. Anthropometric measurements (weight, length, and head size) predicted tractography outcomes. In contrast, subcortical components (cerebellum, hippocampus, olfactory) of a structurally based BDS (derived from CHD mouse mutants), predicted more localized and regional postnatal microstructural differences. Collectively, these findings suggest that brain DTI connectome and seed-based tractography are complementary techniques which may facilitate deciphering the mechanistic relative contribution of clinical and genetic risk factors related to poor neurodevelopmental outcomes in CHD.
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Affiliation(s)
- Jodie K. Votava-Smith
- Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Jenna Gaesser
- Department of Neurology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Vince Lee
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Nhu Tran
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine of USC, Children’s Hospital Los Angeles, Fetal and Neonatal Institute, Los Angeles, CA, United States
| | - Vidya Rajagopalan
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Sylvia del Castillo
- Department of Anesthesiology Critical Care Medicine Anesthesiology, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - S. Ram Kumar
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Elizabeth Herrup
- Division of Pediatric Cardiac Intensive Care, Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tracy Baust
- Division of Pediatric Cardiac Intensive Care, Department of Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jennifer A. Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - George C. Gabriel
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - William T. Reynolds
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Julia Wallace
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Benjamin Meyers
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rafael Ceschin
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cecilia W. Lo
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vanessa J. Schmithorst
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States,*Correspondence: Ashok Panigrahy,
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18
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Ortinau CM, Smyser CD, Arthur L, Gordon EE, Heydarian HC, Wolovits J, Nedrelow J, Marino BS, Levy VY. Optimizing Neurodevelopmental Outcomes in Neonates With Congenital Heart Disease. Pediatrics 2022; 150:e2022056415L. [PMID: 36317967 PMCID: PMC10435013 DOI: 10.1542/peds.2022-056415l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Neurodevelopmental impairment is a common and important long-term morbidity among infants with congenital heart disease (CHD). More than half of those with complex CHD will demonstrate some form of neurodevelopmental, neurocognitive, and/or psychosocial dysfunction requiring specialized care and impacting long-term quality of life. Preventing brain injury and treating long-term neurologic sequelae in this high-risk clinical population is imperative for improving neurodevelopmental and psychosocial outcomes. Thus, cardiac neurodevelopmental care is now at the forefront of clinical and research efforts. Initial research primarily focused on neurocritical care and operative strategies to mitigate brain injury. As the field has evolved, investigations have shifted to understanding the prenatal, genetic, and environmental contributions to impaired neurodevelopment. This article summarizes the recent literature detailing the brain abnormalities affecting neurodevelopment in children with CHD, the impact of genetics on neurodevelopmental outcomes, and the best practices for neonatal neurocritical care, focusing on developmental care and parental support as new areas of importance. A framework is also provided for the infrastructure and resources needed to support CHD families across the continuum of care settings.
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Affiliation(s)
- Cynthia M. Ortinau
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Christopher D. Smyser
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Lindsay Arthur
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Erin E. Gordon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Haleh C. Heydarian
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joshua Wolovits
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Nedrelow
- Department of Neonatology, Cook Children’s Medical Center, Fort Worth, Texas
| | - Bradley S. Marino
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Victor Y. Levy
- Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Palo Alto, California
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19
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Bonthrone AF, Chew A, Bhroin MN, Rech FM, Kelly CJ, Christiaens D, Pietsch M, Tournier JD, Cordero-Grande L, Price A, Egloff A, Hajnal JV, Pushparajah K, Simpson J, David Edwards A, Rutherford MA, Nosarti C, Batalle D, Counsell SJ. Neonatal frontal-limbic connectivity is associated with externalizing behaviours in toddlers with Congenital Heart Disease. Neuroimage Clin 2022; 36:103153. [PMID: 35987179 PMCID: PMC9403726 DOI: 10.1016/j.nicl.2022.103153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Children with Congenital Heart Disease (CHD) are at increased risk of neurodevelopmental impairments. The neonatal antecedents of impaired behavioural development are unknown. 43 infants with CHD underwent presurgical brain diffusion-weighted MRI [postmenstrual age at scan median (IQR) = 39.29 (38.71-39.71) weeks] and a follow-up assessment at median age of 22.1 (IQR 22.0-22.7) months in which parents reported internalizing and externalizing problem scores on the Child Behaviour Checklist. We constructed structural brain networks from diffusion-weighted MRI and calculated edge-wise structural connectivity as well as global and local brain network features. We also calculated presurgical cerebral oxygen delivery, and extracted perioperative variables, socioeconomic status at birth and a measure of cognitively stimulating parenting. Lower degree in the right inferior frontal gyrus (partial ρ = -0.687, p < 0.001) and reduced connectivity in a frontal-limbic sub-network including the right inferior frontal gyrus were associated with higher externalizing problem scores. Externalizing problem scores were unrelated to neonatal clinical course or home environment. However, higher internalizing problem scores were associated with earlier surgery in the neonatal period (partial ρ = -0.538, p = 0.014). Our results highlight the importance of frontal-limbic networks to the development of externalizing behaviours and provide new insights into early antecedents of behavioural impairments in CHD.
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Affiliation(s)
- Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Megan Ní Bhroin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Francesca Morassutti Rech
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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20
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Scheinost D, Chang J, Lacadie C, Brennan-Wydra E, Constable RT, Chawarska K, Ment LR. Functional connectivity for the language network in the developing brain: 30 weeks of gestation to 30 months of age. Cereb Cortex 2022; 32:3289-3301. [PMID: 34875024 PMCID: PMC9340393 DOI: 10.1093/cercor/bhab415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 11/14/2022] Open
Abstract
Although the neural scaffolding for language is putatively present before birth, the maturation of functional connections among the key nodes of the language network, Broca's and Wernicke's areas, is less known. We leveraged longitudinal and cross-sectional data from three sites collected through six studies to track the development of functional circuits between Broca's and Wernicke's areas from 30 weeks of gestation through 30 months of age in 127 unique participants. Using resting-state fMRI data, functional connectivity was calculated as the correlation between fMRI time courses from pairs of regions, defined as Broca's and Wernicke's in both hemispheres. The primary analysis evaluated 23 individuals longitudinally imaged from 30 weeks postmenstrual age (fetal) through the first postnatal month (neonatal). A secondary analysis in 127 individuals extended these curves into older infants and toddlers. These data demonstrated significant growth of interhemispheric connections including left Broca's and its homolog and left Wernicke's and its homolog from 30 weeks of gestation through the first postnatal month. In contrast, intrahemispheric connections did not show significant increases across this period. These data represent an important baseline for language systems in the developing brain against which to compare those neurobehavioral disorders with the potential fetal onset of disease.
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Affiliation(s)
- Dustin Scheinost
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
- Department of Statistics & Data Science, Yale University, New Haven, CT 06520, USA
- Child Study Center, Yale School of Medicine, New Haven, CT 06510, USA
| | - Joseph Chang
- Department of Statistics & Data Science, Yale University, New Haven, CT 06520, USA
| | - Cheryl Lacadie
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
| | | | - R Todd Constable
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Katarzyna Chawarska
- Department of Statistics & Data Science, Yale University, New Haven, CT 06520, USA
- Child Study Center, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Laura R Ment
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
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21
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In infants with congenital heart disease autonomic dysfunction is associated with pre-operative brain injury. Pediatr Res 2022; 91:1723-1729. [PMID: 34963700 PMCID: PMC9237187 DOI: 10.1038/s41390-021-01931-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Brain injury is a serious and common complication of critical congenital heart disease (CHD). Impaired autonomic development (assessed by heart rate variability (HRV)) is associated with brain injury in other high-risk neonatal populations. OBJECTIVE To determine whether impaired early neonatal HRV is associated with pre-operative brain injury in CHD. METHODS In infants with critical CHD, we evaluated HRV during the first 24 h of cardiac ICU (CICU) admission using time-domain (RMS 1, RMS 2, and alpha 1) and frequency-domain metrics (LF, nLF, HF, nHF). Pre-operative brain magnetic resonance imaging (MRI) was scored for injury using an established system. Spearman's correlation coefficient was used to determine the association between HRV and pre-operative brain injury. RESULTS We enrolled 34 infants with median birth gestational age of 38.8 weeks (IQR 38.1-39.1). Median postnatal age at pre-operative brain MRI was 2 days (IQR 1-3 days). Thirteen infants had MRI evidence of brain injury. RMS 1 and RMS 2 were inversely correlated with pre-operative brain injury. CONCLUSIONS Time-domain metrics of autonomic function measured within the first 24 h of admission to the CICU are associated with pre-operative brain injury, and may perform better than frequency-domain metrics under non-stationary conditions such as critical illness. IMPACT Autonomic dysfunction, measured by heart rate variability (HRV), in early transition is associated with pre-operative brain injury in neonates with critical congenital heart disease. These data extend our earlier findings by providing further evidence for (i) autonomic dysfunction in infants with CHD, and (ii) an association between autonomic dysfunction and brain injury in critically ill neonates. These data support the notion that further investigation of HRV as a biomarker for brain injury risk is warranted in infants with critical CHD.
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22
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Enguix V, Easson K, Gilbert G, Saint-Martin C, Rohlicek C, Luck D, Lodygensky GA, Brossard-Racine M. Altered resting state functional connectivity in youth with congenital heart disease operated during infancy. PLoS One 2022; 17:e0264781. [PMID: 35427374 PMCID: PMC9012393 DOI: 10.1371/journal.pone.0264781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/16/2022] [Indexed: 12/21/2022] Open
Abstract
Congenital heart disease (CHD) has been associated with structural brain growth and long-term developmental impairments, including deficits in learning, memory, and executive functions. Altered functional connectivity has been shown to be altered in neonates born with CHD; however, it is unclear if these early life alterations are also present during adulthood. Therefore, this study aimed to compare resting state functional connectivity networks associated with executive function deficits between youth (16 to 24 years old) with complex CHD (mean age = 20.13; SD = 2.35) who underwent open-heart surgery during infancy and age- and sex-matched controls (mean age = 20.41; SD = 2.05). Using the Behavior Rating Inventory of Executive Function–Adult Version questionnaire, we found that participants with CHD presented with poorer performance on the inhibit, initiate, emotional control, working memory, self-monitor, and organization of materials clinical scales than healthy controls. We then compared the resting state networks theoretically corresponding to these impaired functions, namely the default mode, dorsal attention, fronto-parietal, fronto-orbital, and amygdalar networks, between the two groups. Participants with CHD presented with decreased functional connectivity between the fronto-orbital cortex and the hippocampal regions and between the amygdala and the frontal pole. Increased functional connectivity was observed within the default mode network, the dorsal attention network, and the fronto-parietal network. Overall, our results suggest that youth with CHD present with disrupted resting state functional connectivity in widespread networks and regions associated with altered executive functioning.
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Affiliation(s)
- Vincente Enguix
- Canadian Neonatal Brain Platform, Montreal, Canada
- Department of Pediatrics, CHU Sainte-Justine Research Center, University of Montreal, Montreal, Canada
| | - Kaitlyn Easson
- Advances in Brain & Child Development (ABCD) Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Christine Saint-Martin
- Department of Medical Imaging, Division of Pediatric Radiology, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Charles Rohlicek
- Department of Pediatrics, Division of Cardiology, Montreal Children’s Hospital, Montreal, QC, Canada
| | - David Luck
- Canadian Neonatal Brain Platform, Montreal, Canada
- Department of Pediatrics, CHU Sainte-Justine Research Center, University of Montreal, Montreal, Canada
| | - Gregory Anton Lodygensky
- Canadian Neonatal Brain Platform, Montreal, Canada
- Department of Pediatrics, CHU Sainte-Justine Research Center, University of Montreal, Montreal, Canada
| | - Marie Brossard-Racine
- Department of Medical Imaging, Division of Pediatric Radiology, Montreal Children’s Hospital, Montreal, QC, Canada
- Department of Pediatrics, Division of Cardiology, Montreal Children’s Hospital, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Division of Neonatology, Montreal Children’s Hospital, Montreal, QC, Canada
- * E-mail:
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23
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Volpe JJ. Fetal origin of brain dysmaturation in congenital heart disease - challenges and opportunities for interventions. J Neonatal Perinatal Med 2022; 15:489-494. [PMID: 35034913 PMCID: PMC9484114 DOI: 10.3233/npm-210942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- J J Volpe
- Department of Neurology, Harvard Medical School, Boston, MA.,Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, MA
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24
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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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25
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Morton SU, Maleyeff L, Wypij D, Yun HJ, Rollins CK, Watson CG, Newburger JW, Bellinger DC, Roberts AE, Rivkin MJ, Grant PE, Im K. Abnormal Right-Hemispheric Sulcal Patterns Correlate with Executive Function in Adolescents with Tetralogy of Fallot. Cereb Cortex 2021; 31:4670-4680. [PMID: 34009260 PMCID: PMC8408447 DOI: 10.1093/cercor/bhab114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Abstract
Neurodevelopmental disabilities are the most common noncardiac conditions in patients with congenital heart disease (CHD). Executive function skills have been frequently observed to be decreased among children and adults with CHD compared with peers, but a neuroanatomical basis for the association is yet to be identified. In this study, we quantified sulcal pattern features from brain magnetic resonance imaging data obtained during adolescence among 41 participants with tetralogy of Fallot (ToF) and 49 control participants using a graph-based pattern analysis technique. Among patients with ToF, right-hemispheric sulcal pattern similarity to the control group was decreased (0.7514 vs. 0.7553, P = 0.01) and positively correlated with neuropsychological testing values including executive function (r = 0.48, P < 0.001). Together these findings suggest that sulcal pattern analysis may be a useful marker of neurodevelopmental risk in patients with CHD. Further studies may elucidate the mechanisms leading to different alterations in sulcal patterning.
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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
| | - Caitlin K Rollins
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, 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, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- 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, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Radiology, Boston Children’s Hospital, Boston, MA 02115, USA
- Stroke and Cerebrovascular Center, Boston Children’s Hospital, Boston, MA 02115, 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
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - 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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26
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Functional Connectivity-Derived Optimal Gestational-Age Cut Points for Fetal Brain Network Maturity. Brain Sci 2021; 11:brainsci11070921. [PMID: 34356155 PMCID: PMC8304646 DOI: 10.3390/brainsci11070921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/08/2023] Open
Abstract
The architecture of the human connectome changes with brain maturation. Pivotal to understanding these changes is defining developmental periods when transitions in network topology occur. Here, using 110 resting-state functional connectivity data sets from healthy fetuses between 19 and 40 gestational weeks, we estimated optimal gestational-age (GA) cut points for dichotomizing fetuses into 'young' and 'old' groups based on global network features. We computed the small-world index, normalized clustering and path length, global and local efficiency, and modularity from connectivity matrices comprised 200 regions and their corresponding pairwise connectivity. We modeled the effect of GA at scan on each metric using separate repeated-measures generalized estimating equations. Our modeling strategy involved stratifying fetuses into 'young' and 'old' based on the scan occurring before or after a selected GA (i.e., 28 to 33). We then used the quasi-likelihood independence criterion statistic to compare model fit between 'old' and 'young' cohorts and determine optimal cut points for each graph metric. Trends for all metrics, except for global efficiency, decreased with increasing gestational age. Optimal cut points fell within 30-31 weeks for all metrics coinciding with developmental events that include a shift from endogenous neuronal activity to sensory-driven cortical patterns.
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27
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Abstract
Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.
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28
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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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29
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De Asis-Cruz J, Andersen N, Kapse K, Khrisnamurthy D, Quistorff J, Lopez C, Vezina G, Limperopoulos C. Global Network Organization of the Fetal Functional Connectome. Cereb Cortex 2021; 31:3034-3046. [PMID: 33558873 DOI: 10.1093/cercor/bhaa410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 12/21/2022] Open
Abstract
Recent advances in brain imaging have enabled non-invasive in vivo assessment of the fetal brain. Characterizing brain development in healthy fetuses provides baseline measures for identifying deviations in brain function in high-risk clinical groups. We examined 110 resting state MRI data sets from fetuses at 19 to 40 weeks' gestation. Using graph-theoretic techniques, we characterized global organizational features of the fetal functional connectome and their prenatal trajectories. Topological features related to network integration (i.e., global efficiency) and segregation (i.e., clustering) were assessed. Fetal networks exhibited small-world topology, showing high clustering and short average path length relative to reference networks. Likewise, fetal networks' quantitative small world indices met criteria for small-worldness (σ > 1, ω = [-0.5 0.5]). Along with this, fetal networks demonstrated global and local efficiency, economy, and modularity. A right-tailed degree distribution, suggesting the presence of central areas that are more highly connected to other regions, was also observed. Metrics, however, were not static during gestation; measures associated with segregation-local efficiency and modularity-decreased with advancing gestational age. Altogether, these suggest that the neural circuitry underpinning the brain's ability to segregate and integrate information exists as early as the late 2nd trimester of pregnancy and reorganizes during the prenatal period. Significance statement. Mounting evidence for the fetal origins of some neurodevelopmental disorders underscores the importance of identifying features of healthy fetal brain functional development. Alterations in prenatal brain connectomics may serve as early markers for identifying fetal-onset neurodevelopmental disorders, which in turn provide improved surveillance of at-risk fetuses and support the initiation of early interventions.
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Affiliation(s)
- Josepheen De Asis-Cruz
- Developing Brain Institute, Children's National, 111 Michigan Ave NW, Washington DC 20010
| | - Nicole Andersen
- Developing Brain Institute, Children's National, 111 Michigan Ave NW, Washington DC 20010
| | - Kushal Kapse
- Developing Brain Institute, Children's National, 111 Michigan Ave NW, Washington DC 20010
| | | | - Jessica Quistorff
- Developing Brain Institute, Children's National, 111 Michigan Ave NW, Washington DC 20010
| | - Catherine Lopez
- Developing Brain Institute, Children's National, 111 Michigan Ave NW, Washington DC 20010
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, 111 Michigan Ave NW, Washington DC 20010
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30
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Bekiesinska-Figatowska M. Editorial for "3D Volumetric MRI Detects Early Alterations of the Brain Growth in Fetuses with Congenital Heart Disease". J Magn Reson Imaging 2021; 54:273-274. [PMID: 33543806 DOI: 10.1002/jmri.27522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
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Feldmann M, Guo T, Miller SP, Knirsch W, Kottke R, Hagmann C, Latal B, Jakab A. Delayed maturation of the structural brain connectome in neonates with congenital heart disease. Brain Commun 2020; 2:fcaa209. [PMID: 33381759 PMCID: PMC7756099 DOI: 10.1093/braincomms/fcaa209] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
There is emerging evidence for delayed brain development in neonates with congenital heart disease. We hypothesize that the perioperative development of the structural brain connectome is a proxy to such delays. Therefore, we set out to quantify the alterations and longitudinal pre- to post-operative changes in the connectome in congenital heart disease neonates relative to healthy term newborns and assess factors contributing to disturbed perioperative network development. In this prospective cohort study, 114 term neonates with congenital heart disease underwent cardiac surgery at the University Children's Hospital Zurich. Forty-six healthy term newborns were included as controls. Pre- and post-operative structural connectomes were derived from mean fractional anisotropy values of fibre pathways traced using diffusion MR tractography. Graph theory parameters calculated across a proportional cost threshold range were compared between groups by multi-threshold permutation correction adjusting for confounders. Network-based statistic was calculated for edgewise network comparison. White-matter injury volume was quantified on 3D T1-weighted images. Random coefficient mixed models with interaction terms of (i) cardiac subtype and (ii) injury volume with post-menstrual age at MRI, respectively, were built to assess modifying effects on network development. Pre- and post-operatively, at the global level, efficiency, indicative of network integration, was lower in heart disease neonates than controls. In contrast, local efficiency and transitivity, indicative of network segregation, were higher compared to controls (all P < 0.025 for one-sided t-tests). Pre-operatively, these group differences were also found across multiple widespread nodes (all P < 0.025, accounting for multiple comparison), whereas post-operatively nodal differences were not evident. At the edge-level, the majority of weaker connections in heart disease neonates compared to controls involved inter-hemispheric connections (66.7% pre-operatively; 54.5% post-operatively). A trend showing a more rapid pre- to post-operative decrease in local efficiency was found in class I cardiac sub-type (biventricular defect without aortic arch obstruction) compared to controls. In congenital heart disease neonates, larger white-matter injury volume was associated with lower strength (P = 0.0026) and global efficiency (P = 0.0097). The maturation of the structural connectome is delayed in congenital heart disease neonates, with a pattern of lower structural integration and higher segregation compared to controls. Trend-level evidence indicated that normalized post-operative cardiac physiology in class I sub-types might improve structural network topology. In contrast, the burden of white-matter injury negatively impacts network strength and integration. Further research is needed to elucidate how aberrant structural network development in congenital heart disease represents neural correlates of later neurodevelopmental impairments.
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Affiliation(s)
- Maria Feldmann
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Ting Guo
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto ON M5G 0A4, Canada
- Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto ON M5G 0A4, Canada
| | - Steven P Miller
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto ON M5G 0A4, Canada
- Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto ON M5G 0A4, Canada
| | - Walter Knirsch
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Andras Jakab
- Centre for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
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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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Ní Bhroin M, Abo Seada S, Bonthrone AF, Kelly CJ, Christiaens D, Schuh A, Pietsch M, Hutter J, Tournier JD, Cordero-Grande L, Rueckert D, Hajnal JV, Pushparajah K, Simpson J, Edwards AD, Rutherford MA, Counsell SJ, Batalle D. Reduced structural connectivity in cortico-striatal-thalamic network in neonates with congenital heart disease. Neuroimage Clin 2020; 28:102423. [PMID: 32987301 PMCID: PMC7520425 DOI: 10.1016/j.nicl.2020.102423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
Impaired brain development has been observed in newborns with congenital heart disease (CHD). We performed graph theoretical analyses and network-based statistics (NBS) to assess global brain network topology and identify subnetworks of altered connectivity in infants with CHD prior to cardiac surgery. Fifty-eight infants with critical/serious CHD prior to surgery and 116 matched healthy controls as part of the developing Human Connectome Project (dHCP) underwent MRI on a 3T system and high angular resolution diffusion MRI (HARDI) was obtained. Multi-tissue constrained spherical deconvolution, anatomically constrained probabilistic tractography (ACT) and spherical-deconvolution informed filtering of tractograms (SIFT2) was used to construct weighted structural networks. Network topology was assessed and NBS was used to identify structural connectivity differences between CHD and control groups. Structural networks were partitioned into core and peripheral nodes, and edges classed as core, peripheral, or feeder. NBS identified one subnetwork with reduced structural connectivity in CHD infants involving basal ganglia, amygdala, hippocampus, cerebellum, vermis, and temporal and parieto-occipital lobe, primarily affecting core nodes and edges. However, we did not find significantly different global network characteristics in CHD neonates. This locally affected sub-network with reduced connectivity could explain, at least in part, the neurodevelopmental impairments associated with CHD.
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Affiliation(s)
- Megan Ní Bhroin
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Ireland
| | - Samy Abo Seada
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Andreas Schuh
- Department of Computing, Imperial College London, London, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lucillio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kuberan Pushparajah
- Paediatric Cardiology Department, Evelina London Children's Healthcare, London, UK
| | - John Simpson
- Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Ji W, Ferdman D, Copel J, Scheinost D, Shabanova V, Brueckner M, Khokha MK, Ment LR. De novo damaging variants associated with congenital heart diseases contribute to the connectome. Sci Rep 2020; 10:7046. [PMID: 32341405 PMCID: PMC7184603 DOI: 10.1038/s41598-020-63928-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
Congenital heart disease (CHD) survivors are at risk for neurodevelopmental disability (NDD), and recent studies identify genes associated with both disorders, suggesting that NDD in CHD survivors may be of genetic origin. Genes contributing to neurogenesis, dendritic development and synaptogenesis organize neural elements into networks known as the connectome. We hypothesized that NDD in CHD may be attributable to genes altering both neural connectivity and cardiac patterning. To assess the contribution of de novo variants (DNVs) in connectome genes, we annotated 229 published NDD genes for connectome status and analyzed data from 3,684 CHD subjects and 1,789 controls for connectome gene mutations. CHD cases had more protein truncating and deleterious missense DNVs among connectome genes compared to controls (OR = 5.08, 95%CI:2.81-9.20, Fisher's exact test P = 6.30E-11). When removing three known syndromic CHD genes, the findings remained significant (OR = 3.69, 95%CI:2.02-6.73, Fisher's exact test P = 1.06E-06). In CHD subjects, the top 12 NDD genes with damaging DNVs that met statistical significance after Bonferroni correction (PTPN11, CHD7, CHD4, KMT2A, NOTCH1, ADNP, SMAD2, KDM5B, NSD2, FOXP1, MED13L, DYRK1A; one-tailed binomial test P ≤ 4.08E-05) contributed to the connectome. These data suggest that NDD in CHD patients may be attributable to genes that alter both cardiac patterning and the connectome.
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Affiliation(s)
- Weizhen Ji
- Departments of Pediatrics, New Haven, CT, USA
| | | | - Joshua Copel
- Departments of Pediatrics, New Haven, CT, USA
- Obstetrics, Gynecology and Reproductive Sciences, New Haven, CT, USA
| | | | | | - Martina Brueckner
- Departments of Pediatrics, New Haven, CT, USA
- Genetics, New Haven, CT, USA
- Yale Combined Program in Biological and Biomedical Sciences, New Haven, CT, USA
| | - Mustafa K Khokha
- Departments of Pediatrics, New Haven, CT, USA
- Genetics, New Haven, CT, USA
| | - Laura R Ment
- Departments of Pediatrics, New Haven, CT, USA.
- Neurology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, USA.
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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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Abstract
Developmental pathoconnectomics is an emerging field that aims to unravel the events leading to and outcome from disrupted brain connectivity development. Advanced magnetic resonance imaging (MRI) technology enables the portrayal of human brain connectivity before birth and has the potential to offer novel insights into normal and pathological human brain development. This review gives an overview of the currently used MRI techniques for connectomic imaging, with a particular focus on recent studies that have successfully translated these to the in utero or postmortem fetal setting. Possible mechanisms of how pathologies, maternal, or environmental factors may interfere with the emergence of the connectome are considered. The review highlights the importance of advanced image post processing and the need for reproducibility studies for connectomic imaging. Further work and novel data-sharing efforts would be required to validate or disprove recent observations from in utero connectomic studies, which are typically limited by low case numbers and high data drop out. Novel knowledge with regard to the ontogenesis, architecture, and temporal dynamics of the human brain connectome would lead to the more precise understanding of the etiological background of neurodevelopmental and mental disorders. To achieve this goal, this review considers the growing evidence from advanced fetal connectomic imaging for the increased vulnerability of the human brain during late gestation for pathologies that might lead to impaired connectome development and subsequently interfere with the development of neural substrates serving higher cognition.
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White BR, Rogers LS, Kirschen MP. Recent advances in our understanding of neurodevelopmental outcomes in congenital heart disease. Curr Opin Pediatr 2019; 31:783-788. [PMID: 31693588 PMCID: PMC6852883 DOI: 10.1097/mop.0000000000000829] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Patients with congenital heart disease (CHD) suffer from a pattern of neurodevelopmental abnormalities including deficits in language and executive function. In this review, we summarize recent studies that examine these outcomes, their risk factors, possible biomarkers, and attempts to develop therapeutic interventions. RECENT FINDINGS The latest literature has highlighted the role of genetics in determining neurologic prognosis, as we have increased our understanding of potentially modifiable perioperative risk factors. The role of potentially neurotoxic medical therapies has become more salient. One recent focus has been how neurodevelopment affects quality of life and leads to a high prevalence of mental illness. Neuroimaging advances have provided new insights into the pathogenesis of deficits. SUMMARY Although many risk factors in CHD are not modifiable, there is promise for interventions to improve neurodevelopmental outcomes in patients with CHD. Biomarkers are needed to better understand the timing and prognosis of injury and to direct therapy. Research into psychosocial interventions is urgently needed to benefit the many survivors with CHD.
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Affiliation(s)
- Brian R. White
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Lindsay S. Rogers
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Matthew P. Kirschen
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
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Sigmon ER, Kelleman M, Susi A, Nylund CM, Oster ME. Congenital Heart Disease and Autism: A Case-Control Study. Pediatrics 2019; 144:peds.2018-4114. [PMID: 31601611 DOI: 10.1542/peds.2018-4114] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There has long been an association between congenital heart disease (CHD) and general neurodevelopmental delays. However, the association between CHD and autism spectrum disorders (AuSDs) is less well understood. Using administrative data, we sought to determine the association between CHD and AuSD and identify specific CHD lesions with higher odds of developing AuSD. METHODS We performed a 1:3 case-control study of children enrolled in the US Military Health System from 2001 to 2013. Children with International Classification of Disease, Ninth Revision, Clinical Modification codes for AuSD were identified as cases and matched with controls on the basis of date of birth, sex, and enrollment time frame. Each child's records were reviewed for CHD lesions and associated procedures. Conditional logistic regression determined odds ratios (ORs) and 95% confidence intervals (CIs) for comparative associations. RESULTS There were 8760 cases with AuSD and 26 280 controls included in the study. After adjustment for genetic syndrome, maternal age, gestational diabetes, short gestation, newborn epilepsy, birth asphyxia, and low birth weight, there were increased odds of AuSD in patients with CHD (OR 1.32; 95% CI 1.10-1.59). Specific lesions with significant OR included atrial septal defects (n = 82; OR 1.72; 95% CI 1.07-2.74) and ventricular septal defects (n = 193; OR 1.65; 95% CI 1.21-2.25). CONCLUSIONS Children with CHD have increased odds of developing AuSD. Specific lesions associated with increased risk include atrial septal defects and ventricular septal defects. These findings will be useful for counseling parents of children with CHD.
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Affiliation(s)
- Eric R Sigmon
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta and.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
| | - Michael Kelleman
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
| | - Apryl Susi
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Cade M Nylund
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Matthew E Oster
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta and .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; and
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Bouyssi-Kobar M, De Asis-Cruz J, Murnick J, Chang T, Limperopoulos C. Altered Functional Brain Network Integration, Segregation, and Modularity in Infants Born Very Preterm at Term-Equivalent Age. J Pediatr 2019; 213:13-21.e1. [PMID: 31358292 PMCID: PMC6765421 DOI: 10.1016/j.jpeds.2019.06.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the functional network organization of the brain in infants born very preterm at term-equivalent age and to relate network alterations to known clinical risk factors for poor neurologic outcomes in prematurity. STUDY DESIGN Resting-state functional magnetic resonance imaging data from 66 infants born very preterm (gestational age <32 weeks and birth weight <1500 g) and 66 healthy neonates born at full term, acquired as part of a prospective, cross-sectional study, were compared at term age using graph theory. Features of resting-state networks, including integration, segregation, and modularity, were derived from correlated hemodynamic activity arising from 93 cortical and subcortical regions of interest and compared between groups. RESULTS Despite preserved small-world topology and modular organization, resting-state networks of infants born very preterm at term-equivalent age were less segregated and less integrated than those of infants born full term. Chronic respiratory illness (ie, bronchopulmonary dysplasia and the length of oxygen support) was associated with decreased global efficiency and increased path lengths (P < .05). In both cohorts, 4 functional modules with similar composition were observed (parietal/temporal, frontal, subcortical/limbic, and occipital). The density of connections in 3 of the 4 modules was decreased in the very preterm network (P < .01); however, in the occipital/visual cortex module, connectivity was increased in infants born very preterm relative to control infants (P < .0001). CONCLUSIONS Early exposure to the ex utero environment is associated with altered resting-state network functional organization in infants born very preterm at term-equivalent age, likely reflecting disrupted brain maturational processes.
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Affiliation(s)
- Marine Bouyssi-Kobar
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC,Institute for Biomedical Sciences, George Washington University, Washington, DC
| | - Josepheen De Asis-Cruz
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC
| | - Jonathan Murnick
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC
| | - Taeun Chang
- Department of Neurology, Children’s National Health System, Washington, DC
| | - Catherine Limperopoulos
- The Developing Brain Research Laboratory, Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
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Placental Pathology and Neuroimaging Correlates in Neonates with Congenital Heart Disease. Sci Rep 2019; 9:4137. [PMID: 30858514 PMCID: PMC6411739 DOI: 10.1038/s41598-019-40894-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/19/2019] [Indexed: 01/20/2023] Open
Abstract
Congenital heart disease (CHD) is an independent risk factor for brain injury, including stroke, and poor neurodevelopmental outcomes, and placental abnormalities may represent an additional risk factor for brain injury in neonates. The incidence and scope of placental pathology and relationship to fetal brain abnormalities in pregnancies complicated by fetal CHD has not been explored to our knowledge. In order to determine the prevalence of placental pathology findings and whether placental findings are associated with postnatal brain injury in pregnancies complicated by fetal CHD, we reviewed placental pathology reports for 51 pregnancies complicated by CHD and scored available postnatal, pre-operative brain MRI for brain pathology. Overall, 57% of CHD infants had abnormal placental pathology. Pregnancies complicated by CHD with aortic obstruction (AO) were significantly more likely than those with no obstruction to have abnormal placental pathology (79% vs. 44%). There was a trend toward more severe brain lesions amongst patients with brain lesions and placental abnormality (55% moderate/severe) compared to those without placental abnormality (11% moderate/severe). These data suggest that placental abnormalities are common in CHD and may have a compounding effect on brain lesions in this high-risk population.
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Leonetti C, Back SA, Gallo V, Ishibashi N. Cortical Dysmaturation in Congenital Heart Disease. Trends Neurosci 2019; 42:192-204. [PMID: 30616953 PMCID: PMC6397700 DOI: 10.1016/j.tins.2018.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 01/09/2023]
Abstract
Congenital heart disease (CHD) is among the most common birth defects. Children with CHD frequently display long-term intellectual and behavioral disability. Emerging evidence indicates that cardiac anomalies lead to a reduction in cerebral oxygenation, which appears to profoundly impact on the maturation of cerebral regions responsible for higher-order cognitive functions. In this review we focus on the potential mechanisms by which dysregulation of cortical neuronal development during early life may lead to the significant cognitive impairments that commonly occur in children with CHD. Further understanding of the mechanisms underlying cortical dysmaturation due to CHD will be necessary to identify strategies for neonatal neuroprotection and for mitigating developmental delays in this patient population.
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Affiliation(s)
- Camille Leonetti
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA; Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA
| | - Stephen A Back
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA; Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Vittorio Gallo
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA.
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA; Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA.
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Zhang H, Shen D, Lin W. Resting-state functional MRI studies on infant brains: A decade of gap-filling efforts. Neuroimage 2019; 185:664-684. [PMID: 29990581 PMCID: PMC6289773 DOI: 10.1016/j.neuroimage.2018.07.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/19/2018] [Accepted: 07/02/2018] [Indexed: 12/16/2022] Open
Abstract
Resting-state functional MRI (rs-fMRI) is one of the most prevalent brain functional imaging modalities. Previous rs-fMRI studies have mainly focused on adults and elderly subjects. Recently, infant rs-fMRI studies have become an area of active research. After a decade of gap filling studies, many facets of the brain functional development from early infancy to toddler has been uncovered. However, infant rs-fMRI is still in its infancy. The image analysis tools for neonates and young infants can be quite different from those for adults. From data analysis to result interpretation, more questions and issues have been raised, and new hypotheses have been formed. With the anticipated availability of unprecedented high-resolution rs-fMRI and dedicated analysis pipelines from the Baby Connectome Project (BCP), it is important now to revisit previous findings and hypotheses, discuss and comment existing issues and problems, and make a "to-do-list" for the future studies. This review article aims to comprehensively review a decade of the findings, unveiling hidden jewels of the fields of developmental neuroscience and neuroimage computing. Emphases will be given to early infancy, particularly the first few years of life. In this review, an end-to-end summary, from infant rs-fMRI experimental design to data processing, and from the development of individual functional systems to large-scale brain functional networks, is provided. A comprehensive summary of the rs-fMRI findings in developmental patterns is highlighted. Furthermore, an extensive summary of the neurodevelopmental disorders and the effects of other hazardous factors is provided. Finally, future research trends focusing on emerging dynamic functional connectivity and state-of-the-art functional connectome analysis are summarized. In next decade, early infant rs-fMRI and developmental connectome study could be one of the shining research topics.
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Affiliation(s)
- Han Zhang
- Department of Radiology and Biomedical Research Imaging Center (BRIC), University of North Carolina at Chapel Hill, NC, 27599, USA
| | - Dinggang Shen
- Department of Radiology and Biomedical Research Imaging Center (BRIC), University of North Carolina at Chapel Hill, NC, 27599, USA; Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea.
| | - Weili Lin
- Department of Radiology and Biomedical Research Imaging Center (BRIC), University of North Carolina at Chapel Hill, NC, 27599, USA.
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Merlocco A. Fetal hemodymanic effects on ductus arteriosus development and influences on postnatal management in infants with ductal-dependent pulmonary blood flow. CONGENIT HEART DIS 2018; 14:100-104. [PMID: 30512232 DOI: 10.1111/chd.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022]
Abstract
The ductus arteriosus (DA) has been studied since Galen. Initially after birth in neonates with obstruction to pulmonary blood flow, DA patency is integral to ensure output and oxygenation. While DA stenting dates back 25 years, there is emerging interest in better understanding how and when to utilize this strategy as an alternative to surgical shunt placement or ongoing prostaglandin administration. Understanding the normal fetal circulation and the perturbations that affect flow and oxygenation is integral to comprehending how normal DA anatomy and morphology may change and how this may influence technical and clinical considerations. In the normal human fetus the great majority of descending aorta circulation comes from the DA, whereas this is a small minority in pulmonary outflow lesions, resulting in size and angle abnormalities. Study of the DA morphology has previously sought to identify patients requiring early intervention and more novel classifications are contributing to knowledge of complications and increasing the likelihood of success. As well, optimal patient selection for aorto-pulmonary shunt vs DA stent remains unclear. This review seeks to convey how fetal circulation can affect the DA, how other clinical considerations such as neurocognitive development support these finding and influence management, and emphasize that the variability in the DA will affect suitability for stenting, which requires further study as guidelines and standards are developed.
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Affiliation(s)
- Anthony Merlocco
- Division of Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
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Dagenais L, Materassi M, Desnous B, Vinay MC, Doussau A, Sabeh P, Prud'homme J, BSc KG, Lenoir M, Charron MA, Nuyt AM, Poirier N, Beaulieu-Genest L, Carmant L, Birca A. Superior Performance in Prone in Infants With Congenital Heart Disease Predicts an Earlier Onset of Walking. J Child Neurol 2018; 33:894-900. [PMID: 30226082 DOI: 10.1177/0883073818798194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Infants with congenital heart disease are at risk of impaired neurodevelopment, which frequently manifests as motor delay during their first years of life. This delay is multifactorial in origin and environmental factors, such as a limited experience in prone, may play a role. In this study, we evaluated the motor development of a prospective cohort of 71 infants (37 males) with congenital heart disease at 4 months of age using the Alberta Infant Motor Scales (AIMS). We used regression analyses to determine whether the 4-month AIMS scores predict the ability to walk by 18 months. The influence of demographic and clinical variables was also assessed. Fifty-one infants (71.8%) were able to maintain the prone prop position (AIMS score of ≥3 in prone) at 4 months. Of those, 47 (92.2%) were able to walk by 18 months compared to only 12/20 (60%) of those who did not maintain the position. Higher AIMS scores were predictive of a greater likelihood of walking by 18 months ( P < .001), with the scores in prone having a higher predictive ability compared to those in other positions (Exp(B) 15.2 vs 4.0). Shorter hospital stays and female gender were also associated with an earlier onset of walking. In conclusion, our study demonstrates that early ventral performance in infants with congenital heart disease impacts the age of acquisition of walking and could be used to guide referral to rehabilitation.
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Affiliation(s)
- Lynn Dagenais
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada
| | - Manuela Materassi
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada
| | - Beatrice Desnous
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada.,2 Division of Neurology, Department of Neuroscience, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada
| | - Marie-Claude Vinay
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada
| | - Amélie Doussau
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada
| | - Pascale Sabeh
- 3 CHU Sainte-Justine Research Centre, University of Montréal, Montréal, Québec, Canada
| | - Joelle Prud'homme
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada
| | - Karine Gagnon BSc
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada
| | - Marien Lenoir
- 4 Division of Cardiac Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada
| | - Marc-Antoine Charron
- 3 CHU Sainte-Justine Research Centre, University of Montréal, Montréal, Québec, Canada
| | - Anne Monique Nuyt
- 3 CHU Sainte-Justine Research Centre, University of Montréal, Montréal, Québec, Canada.,5 Department of Pediatrics, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada
| | - Nancy Poirier
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada.,4 Division of Cardiac Surgery, Department of Surgery, University of Montréal, Montréal, Québec, Canada
| | - Laurence Beaulieu-Genest
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada.,5 Department of Pediatrics, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada
| | - Lionel Carmant
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada.,2 Division of Neurology, Department of Neuroscience, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada.,3 CHU Sainte-Justine Research Centre, University of Montréal, Montréal, Québec, Canada.,5 Department of Pediatrics, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada.,These authors contributed equally to this work
| | - Ala Birca
- 1 Clinique d'Investigation Neuro-Cardiaque (CINC), CHU Sainte-Justine, Montréal, Québec, Canada.,2 Division of Neurology, Department of Neuroscience, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada.,3 CHU Sainte-Justine Research Centre, University of Montréal, Montréal, Québec, Canada.,5 Department of Pediatrics, CHU Sainte-Justine and the University of Montréal, Montréal, Québec, Canada.,These authors contributed equally to this work
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