Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada; Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada.
J Pediatr. 2014 May;164(5):1121-1127.e1. doi: 10.1016/j.jpeds.2013.11.033. Epub 2013 Dec 22.
To investigate the relationship between tissue-specific alterations in brain volume and neurobehavioral status in newborns with complex congenital heart defects preoperatively.
Three-dimensional volumetric magnetic resonance imaging was used to calculate tissue-specific brain volumes and a standardized neurobehavioral assessment was performed to assess neurobehavioral status in 35 full-term newborns admitted to the hospital before cardiopulmonary bypass surgery. Multiple linear regression models were performed to evaluate relationships between neurobehavioral status and brain volumes.
Reduced subcortical gray matter (SCGM) volume and increased cerebrospinal fluid (CSF) volume were associated with poor behavioral state regulation (SCGM, P = .04; CSF, P = .007) and poor visual orienting (CSF, P = .003). In cyanotic newborns, reduced SCGM was associated with higher overall abnormal scores on the assessment (P = .001) and poor behavioral state regulation (P = .04), and increased CSF volume was associated with poor behavioral state regulation (P = .02), and poor visual orienting (P = .02). Conversely, acyanotic newborns showed associations between reduced cerebellar volume and poor behavioral state regulation (P = .03).
Abnormal neurobehavior is associated with impaired volumetric brain growth before open heart surgery in infants with complex congenital heart defects. This study highlights a need for routine preoperative screening and early intervention to improve neurodevelopmental outcomes.
探讨术前患有复杂先天性心脏缺陷的新生儿脑容量与神经行为状态之间的关系。
使用三维容积磁共振成像来计算特定于组织的脑容量，并对 35 名在体外循环手术前住院的足月新生儿进行标准化神经行为评估，以评估其神经行为状态。采用多元线性回归模型评估神经行为状态与脑容量之间的关系。
皮质下灰质（SCGM）体积减少和脑脊液（CSF）体积增加与行为状态调节不良（SCGM，P =.04；CSF，P =.007）和视觉定向不良（CSF，P =.003）有关。在发绀性新生儿中，SCGM 减少与评估中的整体异常评分较高（P =.001）和行为状态调节不良（P =.04）有关，CSF 体积增加与行为状态调节不良（P =.02）和视觉定向不良（P =.02）有关。相反，非发绀性新生儿的小脑体积减少与行为状态调节不良有关（P =.03）。
在患有复杂先天性心脏缺陷的婴儿进行心脏直视手术前，异常的神经行为与脑容量的异常生长有关。本研究强调需要进行常规术前筛查和早期干预，以改善神经发育结局。
