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Original article
Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study
  1. Christopher J Kelly1,
  2. Sophie Arulkumaran1,
  3. Catarina Tristão Pereira1,
  4. Lucilio Cordero-Grande1,
  5. Emer J Hughes1,
  6. Rui Pedro A G Teixeira1,
  7. Johannes K Steinweg1,
  8. Suresh Victor1,
  9. Kuberan Pushparajah2,3,
  10. Joseph V Hajnal1,
  11. John Simpson4,
  12. A David Edwards1,
  13. Mary A Rutherford1,
  14. Serena J Counsell1
  1. 1 Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
  2. 2 School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
  3. 3 Paediatric Cardiology Department, Evelina London Children’s Healthcare, London, UK
  4. 4 Congenital Heart Disease, Evelina London Children’s Hospital, London, London, UK
  1. Correspondence to Professor Mary A Rutherford, Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London WC2R 2LS, UK; mary.rutherford{at}kcl.ac.uk

Abstract

Objectives Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.

Study design Prospective observational study.

Setting Single centre UK tertiary neonatal intensive care unit.

Patients 70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.

Main outcome measures Prevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.

Results Brain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.

Conclusions Cerebral injury in newborns with CHD prior to surgery is common.

  • neonatology
  • cardiology
  • neurodevelopment
  • imaging
  • cardiac surgery

https://doi.org/10.1136/archdischild-2018-314822

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    Footnotes

    • Contributors CJK and SJC contributed to study design, data collection, data analysis, data interpretation, literature search, figures and writing the manuscript. SA contributed to data interpretation. CTP contributed to data analysis. LC-G contributed to data reconstruction. EH, JKS and SV assisted with data collection. RPAGT and JVH contributed to data acquisition. KP contributed to data interpretation. JS contributed to study design and data interpretation. ADE and MAR contributed to data interpretation and writing the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version to be published.

    • Funding This research was funded by the British Heart Foundation (FS/15/55/31649) and Medical Research Council UK (MR/L011530/1). This work received funding from the European Research Council under the European Union’s Seventh Framework Programme (FP7/20072013)/ERC grant agreement no 319456 (dHCP project), and was supported by the Wellcome EPSRC Centre for Medical Engineering at Kings College London (WT 203148/Z/16/Z), MRC strategic grant MR/K006355/1 and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request.

    • Patient consent for publication Not required.