Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease.
Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease.
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DOI：
10.1016/j.jacc.2018.02.068
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发表时间：
2018-05-08
影响因子：
24
通讯作者：
McQuillen PS
中科院分区：
文献类型：
--
作者：
Peyvandi S;Chau V;Guo T;Xu D;Glass HC;Synnes A;Poskitt K;Barkovich AJ;Miller SP;McQuillen PS
据报道，60% 患有严重先天性心脏病 (CHD) 的新生儿会出现脑损伤 (BI)，例如白质损伤 (WMI) 或中风。据报道，这些患者存在神经发育（ND）障碍。新生儿 BI 和 ND 结果之间的关系尚未确定。旨在确定单心室生理学 (SVP) 和 d- 大动脉转位 (TGA) 婴儿围手术期 BI 和 ND 结局之间的关联。患有 TGA 和 SVP 的足月新生儿在 12 个月和 30 个月时接受术前和术后脑部 MRI 以及 ND 结果评估，并使用贝利婴儿发育量表 II 进行评估。 BI 按脑损伤严重程度评分进行分类，WMI 通过体积分析进行量化。 104 名婴儿在 12 个月时进行了随访，70 名婴儿在 30 个月时进行了随访。 12 个月时，只有临床变量与 ND 结果相关。 30 个月时，在调整各种因素后，与无/极少 WMI 的受试者相比，中度至重度 WMI 受试者的 TGA 和 SVP 精神运动发育指数 (PDI) 得分显着降低（低 13 分）（p = 0.03 和 0.05）。定量 WMI 体积也同样相关。中风与结果无关。 12 个月和 30 个月时 PDI 分数的 Bland-Altman 一致性极限在平均 PDI 值范围内很宽（-40.3 至 31.2）。对于患有严重先心病的婴儿来说，WMI 负担的增加与 30 个月时较差的运动结局相关，而小中风与结局之间没有发现不良关联。这些结果支持新生儿脑 MRI 在该人群中的实用性，以帮助预测后期结果以及 ND 随访超过一岁的重要性。
Brain injury (BI) is reported in 60% of newborns with critical congenital heart disease (CHD) as white matter injury (WMI) or stroke. Neurodevelopmental (ND) impairments are reported in these patients. The relationship between neonatal BI and ND outcome has not been established. To determine the association between peri-operative BI and ND outcomes in infants with single ventricle physiology (SVP) and d- Transposition of the great arteries (TGA). Term newborns with TGA and SVP had pre- and post-operative brain MRIs and ND outcomes assessed at 12 and 30 months with Bayley Scales of Infant Development-II. BI was categorized by the Brain Injury Severity score and WMI was quantified by volumetric analysis. 104 infants had follow-up at 12 months and 70 at 30 months. At 12 months, only clinical variables were associated with ND outcome. At 30 months, subjects with moderate-severe WMI had significantly lower psychomotor development index (PDI) scores (13 points lower) as compared to those with none/minimal WMI for TGA and SVP (p= 0.03 and 0.05) after adjusting for various factors. Quantitative WMI volume was likewise associated. Stroke was not associated with outcome. The Bland-Altman limits of agreement for PDI scores at 12 and 30 months were wide (−40.3 to 31.2) across the range of mean PDI values. Increasing burden of WMI is associated with worse motor outcomes at 30 months for infants with critical CHD while no adverse association was seen between small strokes and outcome. These results support the utility of neonatal brain MRI in this population to aid in predicting later outcomes and the importance of ND follow-up beyond one year of age.
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影响因子：
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作者：
Miller, SP;McQuillen, PS;Karl, TR
通讯作者：
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DOI：
10.1016/j.jtcvs.2009.04.061
发表时间：
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