Neuropediatrics 2006; 37 - TP29
DOI: 10.1055/s-2006-945622

THE PRE-OPERATIVE MRI ABNORMALITIES ARE COMMON IN FULL-TERM INFANTS WITH SEVERE CHD AND RESEMBLE LESIONS IN PRE-TERM INFANTS

S Agner 1, J Wang 1, S Tabbutt 1, D Silvestre 1, S Nicolson 1, L Montenegro 1, S Durning 1, D Shera 1, W Gaynor 1, T Spray 1, J Detre 1, G Wernovsky 1, R Clancy 1, R Zimmerman 1
  • 1-

Objectives: As operative survival for early repair of congenital heart defects (CHD) improves, concern for their long-term neurocognitive development grows. The neurocognitive profile for these infants resembles that of very low birthweight infants (VLBW). To assess pre-operative risk factors for poor neurodevelopment, we studied the pre-operative cranial MRIs in 60 full-term neonates with severe forms of CHD.

Methods: Structural brain MRIs were performed preoperatively in 60 patients with severe forms of CHD. Subject inclusion criteria: term birth (40 + 4 weeks GA) absence of birth asphyxia, perinatal depression or cardiopulmonary arrest. MRIs were interpreted by a single neuroradiologist and total brain volumes (TBV) were manually traced.

Results: 60 term infants were studied; 32 male, mean GA 38.7 + 1.3 weeks and mean weight 3.19 + 0.53kg. 16 different CHD diagnoses were studied; hypoplastic left heart syndrome (n=21) was the most common. Mean head circumference (HC) of study subjects (mean 33.7 + 1.6cm), was below that of national normal data (male 33.8 + 1.7cm z=-1.0, female 33.5 + 1.5cm z=-0.8). Total brain volumes (TBV) correlated linearly with HC (r=0.77, p<0.0001). Structural brain abnormalities were seen in over 60% of the cohort (37/60). Microcephaly (defined as <2nd %) was seen in 15% (9/60). An underdeveloped operculum was the most common developmental abnormality (20/60) and periventricular leukomalacia (PVL) was the most common acquired abnormality (13/60). PVL was more common in males than females (31% vs. 7%, p=0.045).

Conclusion: Smaller head circumferences, open operculae and PVL are highly prevalent in this population at birth, and are related more to underlying heart disease rather than the additional effects of bypass and surgery. This pattern of abnormality resembles that seen in VLBW infants, suggesting that infants with severe CHD exhibit brain immaturity or dysmaturity, or share vulnerability mechanisms with premature infants.