Fetal brain growth and risk of postnatal white matter injury in critical congenital heart disease.
Fetal brain growth and risk of postnatal white matter injury in critical congenital heart disease.
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危重先天性心脏病胎儿脑发育与出生后白色物质损伤风险。
DOI：
10.1016/j.jtcvs.2020.09.096
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Seed M
中科院分区：
文献类型：
--
作者：
Peyvandi S;Lim JM;Marini D;Xu D;Reddy VM;Barkovich AJ;Miller S;McQuillen P;Seed M
为了验证以下假设，即大动脉转位（d-TGA）或左心发育不良综合征（HLHS）胎儿的脑发育延迟增加了其出生后对获得性白色损伤的易感性。这是一项跨三个研究中心的队列研究。受试者接受了胎儿（妊娠晚期）和新生儿脑的术前MRI，以测量总脑体积（TBV）作为脑成熟度和出生后获得性脑萎缩的测量。根据经验证的分级标准，将癫痫分类为非轻度或中度-重度。对损伤组进行比较。63例受试者入组（d-TGA：37例; HLHS：26例）。32.4%（n=12）的d-TGA受试者和34.6%（n=8）的HLHS受试者中存在β-内酰胺酶。在校正扫描时的年龄和d-TGA中的部位后，出生后中重度胎儿和新生儿扫描的总体TBV（考虑胎儿和新生儿扫描）显著低于非轻度胎儿和新生儿（Coeff：14.8 mL，95%CI：−28.8，−0.73，p= 0.04）。从胎儿到出生后的TBV变化率在损伤组之间没有差异。在HLHS中，总体TBV或TBV变化与产后出血之间没有相关性。在妊娠晚期开始的较低TBV与d-TGA中出生后中重度妊娠风险增加相关，但与HLHS无关。脑生长速度不是脑梗死的危险因素。潜在的胎儿和围产期生理学对出生后的子宫内膜异位症风险有不同的影响。
To test the hypothesis that delayed brain development in fetuses with d-transposition of the great arteries (d-TGA) or hypoplastic left heart syndrome (HLHS) heightens their postnatal susceptibility to acquired white matter injury (WMI). This is a cohort study across three sites. Subjects underwent fetal (third trimester) and neonatal pre-operative MRI of the brain to measure total brain volume (TBV) as a measure of brain maturity and the presence of acquired WMI after birth. WMI was categorized as none-mild or moderate-severe based on validated grading criteria. Comparisons were made between the injury groups. 63 subjects were enrolled (d-TGA:37; HLHS:26). WMI was present in 32.4% (n=12) of d-TGA and 34.6% (n=8) of HLHS subjects. Overall TBV (taking into account fetal and neonatal scan) was significantly lower in those with postnatal moderate-severe WMI compared to none-mild WMI after adjusting for age at scan and site in d-TGA (Coeff: 14.8 mL, 95%CI: −28.8,−0.73, p= 0.04). The rate of change in TBV from fetal to postnatal life did not differ by injury group. In HLHS, no association was noted between overall TBV or change in TBV with postnatal WMI. Lower TBV beginning in late gestation is associated with increased risk of postnatal moderate-severe WMI in d-TGA but not HLHS. Rate of brain growth was not a risk factor for WMI. The underlying fetal and perinatal physiology has different implications for postnatal risk of WMI.
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影响因子：
24
作者：
Peyvandi S;Chau V;Guo T;Xu D;Glass HC;Synnes A;Poskitt K;Barkovich AJ;Miller SP;McQuillen PS
通讯作者：
McQuillen PS
影响因子：
3.5
作者：
Claessens, N. H. P.;Khalili, N.;Benders, M. J. N. L.
通讯作者：
Benders, M. J. N. L.
影响因子：
37.8
作者：
Limperopoulos C;Tworetzky W;McElhinney DB;Newburger JW;Brown DW;Robertson RL Jr;Guizard N;McGrath E;Geva J;Annese D;Dunbar-Masterson C;Trainor B;Laussen PC;du Plessis AJ
通讯作者：
du Plessis AJ
影响因子：
37.8
作者：
Petit CJ;Rome JJ;Wernovsky G;Mason SE;Shera DM;Nicolson SC;Montenegro LM;Tabbutt S;Zimmerman RA;Licht DJ
通讯作者：
Licht DJ
影响因子：
11.2
作者：
Back SA;Miller SP
通讯作者：
Miller SP