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• W4387601819 abstract "Importance: Congenital heart disease (CHD), especially the complex forms- such as hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA)- have been linked to neurodevelopmental deficits including impairments in gross cognitive functions, language abilities, and visuo-motor skills. The prognostic value of early infant brain trajectories and cumulative impact of demographic factors in relation to childhood neurodevelopmental outcomes is unknown. Objective: To determine whether early structural brain trajectories predict early childhood neurodevelopmental deficits in complex CHD patients and to assess relative cumulative risk profiles of clinical, genetic, and demographic risk factors across early development. Design, Setting, and Participants: We studied a prospective cohort study of term neonates with complex CHD (TGA and HLHS) were recruited at Texas Childrens Hospital between 2005-2011. Participants underwent structural MRI scans at three time points (one preoperative scan, one postoperative scan within 7 days of surgery, and one follow-up postoperative scan at 4 months). Participants also received three neurodevelopmental assessments at 1, 3, and 5 years of age. Main Outcomes and Measures: Brain region volumes (macrostructure) and white matter tract (microstructure) fractional anisotropy (FA) and radial diffusivity (RD) were measured from the MRI scans acquired in the three neonatal time points. Three imaging trajectories- changes in volume, FA and RD, over time- corresponding to periods of brain changes were determined: perioperative (preoperative to postoperative #1), post-surgical (postoperative #1 to postoperative #2), and overall (preoperative #1 to postoperative #2). Gross cognitive, language, and visuo-motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 1 and 3 years, and with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III Full-Scale IQ and Verbal IQ, and Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI)., 6th Edition at 5 years. The analysis included development of predictive multi-variable models incorporating other known risk factors (i.e., heart lesion type, microdeletion-related genetic abnormality, and maternal IQ) of poor neurodevelopmental outcomes in CHD. Results: A total of 95 term (38.5+/-1.3 weeks gestational age) neonates with complex CHD (49 [51.6%] HLHS, 46 [48.4%] TGA; 42 [44.2%] girls) were analyzed. Reduced overall period trajectories predicted poor language outcomes: brainstem (p=0.0022) and white matter (p=0.0397) predicted poor 5-year verbal IQ; brainstem (p=0.0134), deep grey (p=0.0258), and FA of superior longitudinal fasciculus (SLF) (p=0.0256) predicted poor 3-year language; whole brain volume predicted poor performance on measures of language at 1 year. Maternal IQ was the strongest contributor to language outcome variance that increased from 37% at 1-year, up to 62% at 3-year, and up to 81% at 5-year testing. Genetic abnormality contribution to variance in these same models decreased from 41% in 1-year to about 25% at 3-year, and then to not significant in the 5-year assessments. Heart lesion type was found to be not significant in predicting outcomes in these models. Conclusion and Relevance: A dysmaturation pattern of reduced postnatal trajectories of subcortical-cerebral white matter MRI metrics predicted poor early childhood neurodevelopmental outcomes, despite the high relative contribution of maternal IQ. Maternal IQ was cumulative over time, exceeding the influence of known innate cardiac and genetic factors in complex CHD, underscoring the importance of both heritable factors and parent-based environmental factors." @default.
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• W4387601819 date "2023-10-12" @default.
• W4387601819 modified "2023-10-14" @default.
• W4387601819 title "Postnatal Brain Magnetic Resonance Imaging Trajectories and Maternal Intelligence Predict Neurodevelopmental Outcomes in Complex Congenital Heart Disease" @default.
• W4387601819 doi "https://doi.org/10.1101/2023.10.11.23296856" @default.
• W4387601819 hasPublicationYear "2023" @default.
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