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Perioperative neonatal brain injury is associated with worse school‐age neurodevelopment in children with critical congenital heart disease
Author(s) -
Claessens Nathalie H P,
Algra Selma O,
Ouwehand Tom L,
Jansen Nicolaas J G,
Schappin Renske,
Haas Felix,
Eijsermans Maria J C,
Vries Linda S,
Benders Ma J N L
Publication year - 2018
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13747
Subject(s) - wechsler preschool and primary scale of intelligence , perioperative , medicine , internal capsule , pediatrics , bayley scales of infant development , toddler , white matter , intelligence quotient , wechsler adult intelligence scale , wechsler intelligence scale for children , psychology , anesthesia , magnetic resonance imaging , cognition , psychiatry , psychomotor learning , developmental psychology , radiology
Aim To assess the impact of perioperative neonatal brain injury and brain volumes on neurodevelopment throughout school‐age children with critical congenital heart disease ( CHD ). Method Thirty‐four survivors of neonatal cardiac surgery (seven females, 27 males) were included. Neonatal preoperative and postoperative cerebral magnetic resonance imaging was performed and neurodevelopment was assessed at 24 months ( SD 0.7, n =32, using Bayley Score of Infant and Toddler Development, Child Behavior Checklist) and 6 years (mean age 5y 11mo; SD 0.3, n =30, using Movement Assessment Battery for Children, Wechsler Preschool and Primary Scale of Intelligence, Child Behavior Checklist, Teacher Report Form). Brain injury, brain volumes, and cortical measures were related to outcome with adjustment for maternal educational level. Results Two‐year cognitive score and 6‐year Full‐scale IQ were poorer in children with neonatal white matter injury ( n =21, all p <0.05), with higher teacher‐reported attention problems ( p =0.03). Five of six children with involvement of the posterior limb of the internal capsule showed motor problems ( p =0.03). Children with a below‐average Fulll‐scale IQ (<85, n =9) showed smaller volumes of basal ganglia thalami (−8%, p =0.03) and brain stem (−7%, p =0.03). Interpretation Our findings provide evidence of unfavourable outcome in school‐age children with critical CHD who acquire perioperative neonatal brain injury. What this paper adds This paper extends knowledge about neonatal brain injury and long‐term outcome in congenital heart disease. Children with white matter injury show lower IQ and more attention problems at school age. Injury of the posterior limb of the internal capsule increases the risk of motor problems. This study provides evidence for worse outcomes in neonates acquiring brain injury around cardiac surgery.