Child Development Center, University Children's Hospital, Zurich, Switzerland.
Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital, Zurich, Switzerland.
Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):251-259. doi: 10.1053/j.semtcvs.2020.11.029. Epub 2020 Nov 25.
Children with severe congenital heart disease are at risk for neurodevelopmental impairments. We examined brain maturation in infants undergoing neonatal cardiopulmonary bypass surgery or hybrid procedure for hypoplastic left heart syndrome compared to controls. This is a prospective cohort study on term-born infants with congenital heart disease with cerebral MRI pre- and postoperatively. Healthy infants served as controls. Brain maturation was measured using a semiquantitative scoring system. The progress of brain maturation from the preoperative to postoperative MRI within patients was compared. Neurodevelopment was assessed at 1 year with the Bayley Scales of Infant and Toddler Development III. A total of 92 patients with congenital heart disease and 46 controls were studied. Median total maturation score in patients was 12 (interquartile range 10.6-13.0) preoperatively and 14 (12.0-15.0) postoperatively, in controls it was 14 (13.0-15.0). Median time interval between scans was 19 days (interquartile range 14-26). After correction for postmenstrual age at MRI, the pre- and postoperative maturation score was lower in patients compared to controls (preoperative P = 0.01, postoperative P = 0.03) and increased between pre- and postoperative assessment (P ≤ 0.001). Brain maturation scores did not correlate with neurodevelopmental outcome at 1 year, when corrected for socioeconomic status and postmenstrual age at MRI. This study confirms delayed brain maturation in children with congenital heart disease, and despite neonatal cardiac bypass surgery followed by postoperative intensive care medicine brain maturation is ongoing. We encourage further investigation in outcome prediction in this population, potentially by combining more advanced MRI measures with clinical methods.
患有严重先天性心脏病的儿童存在神经发育障碍的风险。我们比较了接受新生儿心肺旁路手术或左心发育不全综合征杂交手术的婴儿与对照组之间的脑成熟情况。这是一项针对患有先天性心脏病的足月出生婴儿的前瞻性队列研究，他们在术前和术后都接受了脑部 MRI 检查。健康婴儿作为对照组。使用半定量评分系统来测量脑成熟度。比较了患者术前和术后 MRI 之间脑成熟度的进展情况。神经发育在 1 岁时使用贝利婴幼儿发育量表第三版进行评估。共研究了 92 名患有先天性心脏病的患者和 46 名对照组。患者的总成熟评分中位数为术前 12 分（四分位距 10.6-13.0），术后 14 分（12.0-15.0），对照组为 14 分（13.0-15.0）。两次扫描之间的中位时间间隔为 19 天（四分位距 14-26）。校正 MRI 时的月经后年龄后，患者的术前和术后成熟评分均低于对照组（术前 P=0.01，术后 P=0.03），并且在术前和术后评估之间增加（P≤0.001）。脑成熟评分与校正社会经济地位和 MRI 时的月经后年龄后的 1 年神经发育结果无关。这项研究证实了先天性心脏病儿童的脑成熟延迟，尽管新生儿心脏旁路手术后进行了术后重症监护治疗，但脑成熟仍在继续。我们鼓励在该人群中通过将更先进的 MRI 测量方法与临床方法相结合来进一步研究预后预测。
