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Congenital Heart Disease Affects Cerebral Size but Not Brain Growth

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Abstract

Infants with congenital heart disease (CHD) have delayed brain maturation and alterations in brain volume. Brain metrics is a simple measurement technique that can be used to evaluate brain growth. This study used brain metrics to test the hypothesis that alterations in brain size persist at 3 months of age and that infants with CHD have slower rates of brain growth than control infants. Fifty-seven infants with CHD underwent serial brain magnetic resonance imaging (MRI). To evaluate brain growth across the first 3 months of life, brain metrics were undertaken using 19 tissue and fluid spaces shown on MRIs performed before surgery and again at 3 months of age. Before surgery, infants with CHD have smaller frontal, parietal, cerebellar, and brain stem measures (p < 0.001). At 3 months of age, alterations persisted in all measures except the cerebellum. There was no difference between control and CHD infants in brain growth. However, the cerebellum trended toward greater growth in infants with CHD. Somatic growth was the primary factor that related to brain growth. Presence of focal white matter lesions before and after surgery did not relate to alterations in brain size or growth. Although infants with CHD have persistent alterations in brain size at 3 months of age, rates of brain growth are similar to that of healthy term infants. Somatic growth was the primary predictor of brain growth, emphasizing the importance of optimal weight gain in this population.

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Abbreviations

RFH:

Right frontal height

LFH:

Left frontal height

RFL:

Right frontal length

LFL:

Left frontal length

BIFD:

Bifrontal diameter

BoBPD:

Bone biparietal diameter

BrBPD:

Brain biparietal diameter

TCD:

Transverse cerebellar diameter

BA:

Brainstem area

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Acknowledgments

This research was supported by grants from the National Heart Foundation of New Zealand; the Green Lane Research and Education Fund; the Auckland Medical Research Fund; the Doris Duke Distinguished Clinical Scientist Award; the National Institutes of Health (NIH) under Ruth L. Kirschstein National Research Service Award no. T32 HD043010; and the Clinical and Translational Science Awards no. UL1RR024992 and P30HD062171 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Data used in the preparation of this article were obtained from the NIH Pediatric MRI Data Repository created by the NIH MRI Study of Normal Brain Development. This is a multisite, longitudinal study of typically developing children from ages newborn through young adulthood conducted by the Brain Development Cooperative Group and supported by the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, the National Institute of Mental Health, and the National Institute of Neurological Disorders and Stroke (Contracts no. N01-HD02-3343; N01-MH9-0002; and N01-NS-9-2314, -2315, -2316, -2317, -2319, and -2320). A listing of the participating sites and a complete listing of the study investigators can be found at http://www.bic.mni.mcgill.ca/nihpd/info/participating_centers.html. This manuscript reflects the view of the authors and may not reflect the opinions or views of the NIH. The authors acknowledge the contributions of the study research nurses, in particular Laura-Clare Whelan, for their assistance with data collection, and the cardiac surgeons, cardiologists, anesthetists, perfusionists, and pediatric intensive care staff at Starship Children’s Hospital for their support of our study. Most importantly, we are thankful to the families who allowed their babies to participate in this study.

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Authors and Affiliations

  1. Department of Pediatrics, St. Louis Children’s Hospital, Washington University in St. Louis, St. Louis, MO, 63110, USA

    Cynthia Ortinau, Terrie Inder & Jennifer Lambeth

  2. Department of Neurology, Washington University in St. Louis, St. Louis, MO, 63110, USA

    Terrie Inder

  3. Mallinkrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, 63110, USA

    Terrie Inder

  4. Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, 63110, USA

    Michael Wallendorf

  5. Department of Pediatric Cardiac Surgery, Starship Children’s Hospital, Auckland, New Zealand

    Kirsten Finucane

  6. Pediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand

    John Beca

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  1. Cynthia Ortinau
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  2. Terrie Inder
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  3. Jennifer Lambeth
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  5. Kirsten Finucane
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  6. John Beca
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Correspondence to Cynthia Ortinau.

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Ortinau, C., Inder, T., Lambeth, J. et al. Congenital Heart Disease Affects Cerebral Size but Not Brain Growth. Pediatr Cardiol 33, 1138–1146 (2012). https://doi.org/10.1007/s00246-012-0269-9

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  • DOI: https://doi.org/10.1007/s00246-012-0269-9

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