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Association of Cerebrovascular Stability Index and Head Circumference Between Infants With and Without Congenital Heart Disease

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Abstract

Congenital heart disease (CHD) is a common birth defect in the United States. CHD infants are more likely to have smaller head circumference and neurodevelopmental delays; however, the cause is unknown. Altered cerebrovascular hemodynamics may contribute to neurologic abnormalities, such as smaller head circumference, thus we created a novel Cerebrovascular Stability Index (CSI), as a surrogate for cerebral autoregulation. We hypothesized that CHD infants would have an association between CSI and head circumference. We performed a prospective, longitudinal study in CHD infants and healthy controls. We measured CSI and head circumference at 4 time points (newborn, 3, 6, 9 months). We calculated CSI by subtracting the average 2-min sitting from supine cerebral oxygenation (rcSO2) over three consecutive tilts (0–90°), then averaged the change score for each age. Linear regressions quantified the relationship between CSI and head circumference. We performed 177 assessments in total (80 healthy controls, 97 CHD infants). The average head circumference was smaller in CHD infants (39.2 cm) compared to healthy controls (41.6 cm) (p < 0.001) and head circumference increased by 0.27 cm as CSI improved in the sample (p = 0.04) overall when combining all time points. Similarly, head circumference increased by 0.32 cm as CSI improved among CHD infants (p = 0.04). We found CSI significantly associated with head circumference in our sample overall and CHD infants alone, which suggests that impaired CSI may affect brain size in CHD infants. Future studies are needed to better understand the mechanism of interaction between CSI and brain growth.

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Acknowledgements

We thank all participating families and staff at the Heart Institute and Fetal Maternal Center of Children’s Hospital Los Angeles for their vital assistance.

Funding

This study was supported by Children’s Hospital Los Angeles Clinical Services Research Grant, SC CTSI (NCATS) through Grant UL1TR0001855, and the NINR K23 Grant 1K23NR019121-01A1. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Neonatology, Children’s Hospital Los Angeles (CHLA), Fetal and Neonatal Institute, 4650 Sunset Blvd., MS#137, Los Angeles, CA, 90027, USA

    Nhu N. Tran

  2. Department of Pediatrics, Keck School of Medicine, University of Southern California (KSOM USC), Los Angeles, CA, USA

    Nhu N. Tran & Jodie K. Votava-Smith

  3. Department of Population and Public Health Sciences, KSOM USC, Los Angeles, CA, USA

    Michelle Tran

  4. Division of Research on Children, Youth, and Families, The Saban Research Institute, CHLA, Los Angeles, CA, USA

    Michelle Tran

  5. Department of Pediatric Radiology, CHLA, Los Angeles, CA, USA

    Ashok Panigrahy

  6. University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Ashok Panigrahy

  7. Lurie Children’s Hospital of Chicago, Anesthesiology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ken M. Brady

  8. Division of Cardiology, Department of Pediatrics, CHLA and KSOM USC, Los Angeles, CA, USA

    Jodie K. Votava-Smith

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  1. Nhu N. Tran
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  5. Jodie K. Votava-Smith
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Contributions

NT conceived the study question and study design. NT performed assessments and collected data. MT performed the data analyses. NT and MT wrote the first draft of the manuscript and all authors provided revisions on the draft. NT verified the analytical methods and oversaw all manuscript revisions. JV, AP, and KB reviewed and edited all versions. All authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Nhu N. Tran.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical Approval

All procedures contributing to this work comply with the ethical standards of the relevant national guidelines on human experimentation (Good Clinical Practice) and with the Helsinki Declaration of 1975, as revised in 2008. The institutional committees (Committee on Clinical Investigations of Children’s Hospital Los Angeles and AltaMed ethics committee) have approved all study procedures.

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We obtained written informed consent from all parents of infants included in this study.

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Tran, N.N., Tran, M., Panigrahy, A. et al. Association of Cerebrovascular Stability Index and Head Circumference Between Infants With and Without Congenital Heart Disease. Pediatr Cardiol 43, 1624–1630 (2022). https://doi.org/10.1007/s00246-022-02891-3

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  • DOI: https://doi.org/10.1007/s00246-022-02891-3

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