Mallory Owen1, Michael Shevell2, Mary Donofrio3, Annette Majnemer4, Robert McCarter5, Gilbert Vezina6, Marine Bouyssi-Kobar7, Iordanis Evangelou7, Dena Freeman7, Neil Weisenfeld8, Catherine Limperopoulos9. 1. 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. 2. Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada. 3. Department of Cardiology, Children's National Medical Center, Washington, DC. 4. Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada; School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada. 5. Department of Biostatistics and Informatics, Children's National Medical Center, Washington, DC. 6. Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC. 7. Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC. 8. Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA. 9. 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. Electronic address: climpero@childrensnational.org.
Abstract
OBJECTIVE: To investigate the relationship between tissue-specific alterations in brain volume and neurobehavioral status in newborns with complex congenital heart defects preoperatively. STUDY DESIGN: 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. RESULTS: 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). CONCLUSION: 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. Published by Mosby, Inc.
OBJECTIVE: To investigate the relationship between tissue-specific alterations in brain volume and neurobehavioral status in newborns with complex congenital heart defects preoperatively. STUDY DESIGN: 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. RESULTS: 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). CONCLUSION: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. Published by Mosby, Inc.
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