Child Development Centre, University Children's Hospital, Zurich, Switzerland.
Children's Research Centre, University Children's Hospital Zurich, Zürich, Switzerland.
Sci Rep. 2019 Jul 26;9(1):10885. doi: 10.1038/s41598-019-47328-9.
Children with congenital heart disease (CHD) remain at risk for neurodevelopmental impairment despite improved perioperative care. Our prospective cohort study aimed to determine the relationship between perioperative brain volumes and neurodevelopmental outcome in neonates with severe CHD. Pre- and postoperative cerebral MRI was acquired in term born neonates with CHD undergoing neonatal cardiopulmonary bypass surgery. Brain volumes were measured using an atlas prior-based automated method. One-year neurodevelopmental outcome was assessed with the Bayley-III. CHD infants (n = 77) had lower pre- and postoperative total and regional brain volumes compared to controls (n = 44, all p < 0.01). CHD infants had poorer cognitive and motor outcome (p ≤ 0.0001) and a trend towards lower language composite score compared to controls (p = 0.06). Larger total and selected regional postoperative brain volumes were found to be associated with better cognitive and language outcomes (all p < 0.04) at one year. This association was independent of length of intensive care unit stay for total, cortical, temporal, frontal and cerebellar volumes. Therefore, reduced cerebral volume in CHD neonates undergoing bypass surgery may serve as a biomarker for impaired outcome.
患有先天性心脏病 (CHD) 的儿童尽管围手术期护理得到改善，但仍存在神经发育受损的风险。我们的前瞻性队列研究旨在确定新生儿严重 CHD 患者围手术期脑容量与神经发育结局之间的关系。对接受新生儿心肺旁路手术的足月出生的 CHD 新生儿进行术前和术后脑 MRI 检查。使用基于图谱的自动方法测量脑容量。使用 Bayley-III 评估 1 年的神经发育结局。与对照组 (n=44) 相比，CHD 婴儿 (n=77) 的术前和术后总脑容量和各区域脑容量均较低 (均 p<0.01)。CHD 婴儿的认知和运动功能更差 (p≤0.0001)，语言综合评分也低于对照组 (p=0.06)。术后总脑容量和部分区域脑容量较大与 1 年后认知和语言功能更好相关 (均 p<0.04)。这种关联独立于总容量、皮质、颞叶、额叶和小脑的 ICU 住院时间。因此，接受旁路手术的 CHD 新生儿脑体积减少可能是预后受损的生物标志物。
