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Pediatr Cardiol. 2023 Jun;44(5):1143-1149. doi: 10.1007/s00246-022-03018-4. Epub 2022 Oct 6.
Complex congenital heart disease (CCHD) is associated with impaired neurodevelopmental outcomes. Peri- and post-operative factors are known contributors while the impact of the prenatal environment is not yet delineated. Variations in fetal circulation, seen in transposition of the great arteries (TGA) and single ventricular physiology (SVP), are associated with placenta abnormalities. These abnormalities may be associated with placental insufficiency, a risk factor for poor neurodevelopmental outcomes. We hypothesized there is a correlation between placental pathology and impaired neurodevelopmental outcomes in patients with CCHD. We performed a single center retrospective cohort study with patients with TGA and SVP from 2010 to 2017 at Children's Wisconsin. Patient variables were obtained from the medical record. Bayley Scales of Infant Development Third Edition standard scores for cognitive, motor, and language performance were collected from neurodevelopmental visits. Placenta pathology reports were reviewed with tabulation of predetermined anatomical and pathological characteristics. We identified 79 patients in our cohort and 61 (77.2%) had abnormal placentas. There was no significant difference between the two groups in any demographic or clinical variables. For cognitive and motor performance, without adjusting for the covariates, infants with placental abnormalities had significantly lower scores compared to infants without (p = 0.026, p = 0.045 respectively). Conversely, there was no significant difference in language scores between the two groups (p = 0.12). Placenta abnormalities are common in patients with CCHD, and placenta abnormalities are associated with impaired neurodevelopmental outcomes. These results underscore the complex causal pathways of neurodevelopmental impairment in infants with CCHD and offer opportunities for targeted postnatal developmental interventions after discharge.
复杂先天性心脏病（CCHD）与神经发育不良结局有关。围手术期和术后因素是已知的致病因素，而产前环境的影响尚未明确。大动脉转位（TGA）和单心室生理学（SVP）中所见的胎儿循环变化与胎盘异常有关。这些异常可能与胎盘功能不全有关，而胎盘功能不全是神经发育不良结局的危险因素。我们假设 CCHD 患者的胎盘病理与神经发育不良结局之间存在相关性。我们对 2010 年至 2017 年期间在威斯康星儿童医院接受 TGA 和 SVP 治疗的患者进行了一项单中心回顾性队列研究。患者变量从病历中获得。从神经发育随访中收集了贝利婴幼儿发展量表第三版的认知、运动和语言表现的标准分数。回顾了胎盘病理报告，并对预定的解剖和病理特征进行了制表。我们在队列中确定了 79 名患者，其中 61 名（77.2%）有异常胎盘。两组在任何人口统计学或临床变量方面均无显著差异。在未调整协变量的情况下，胎盘异常婴儿的认知和运动表现评分明显低于无胎盘异常婴儿（p=0.026，p=0.045）。相反，两组的语言评分无显著差异（p=0.12）。CCHD 患者的胎盘异常很常见，胎盘异常与神经发育不良结局有关。这些结果强调了 CCHD 婴儿神经发育受损的复杂因果途径，并为出院后有针对性的发育干预提供了机会。
