RT Journal Article
SR Electronic
T1 Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 1042
OP 1048
DO 10.1136/archdischild-2018-314822
VO 104
IS 11
A1 Christopher J Kelly
A1 Sophie Arulkumaran
A1 Catarina Tristão Pereira
A1 Lucilio Cordero-Grande
A1 Emer J Hughes
A1 Rui Pedro A G Teixeira
A1 Johannes K Steinweg
A1 Suresh Victor
A1 Kuberan Pushparajah
A1 Joseph V Hajnal
A1 John Simpson
A1 A David Edwards
A1 Mary A Rutherford
A1 Serena J Counsell
YR 2019
UL http://adc.bmj.com/content/104/11/1042.abstract
AB 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.