Brain Injury in Infants with Critical Congenital Heart Disease: Insights from Two Clinical Cohorts with Different Practice Approaches.
Brain
/ pathology
Brain Injuries
/ epidemiology
Cardiac Surgical Procedures
/ adverse effects
Female
Follow-Up Studies
Heart Defects, Congenital
/ complications
Humans
Imaging, Three-Dimensional
/ methods
Infant
Infant, Newborn
Magnetic Resonance Imaging
/ methods
Male
Netherlands
/ epidemiology
Ontario
/ epidemiology
Prevalence
Prognosis
Prospective Studies
Risk Assessment
/ methods
Risk Factors
Journal
The Journal of pediatrics
ISSN: 1097-6833
Titre abrégé: J Pediatr
Pays: United States
ID NLM: 0375410
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
22
04
2019
revised:
06
07
2019
accepted:
10
07
2019
pubmed:
28
8
2019
medline:
19
5
2020
entrez:
28
8
2019
Statut:
ppublish
Résumé
To determine prevalence and risk factors for brain injury in infants with critical congenital heart disease (CHD) from 2 sites with different practice approaches who were scanned clinically. Prospective, longitudinal cohort study (2016-2017) performed at Hospital for Sick Children Toronto (HSC) and Wilhelmina Children's Hospital Utrecht (WKZ), including 124 infants with cardiac surgery ≤60 days (HSC = 77; WKZ = 47). Magnetic resonance imaging was performed per clinical protocol, preoperatively (n = 100) and postoperatively (n = 120). Images were reviewed for multifocal (watershed, white matter injury) and focal ischemic injury (stroke, single white matter lesion). The prevalence of ischemic injury was 69% at HSC and 60% at WKZ (P = .20). Preoperative multifocal injury was associated with low cardiac output syndrome (OR, 4.6), which was equally present at HSC and WKZ (20% vs 28%; P = .38). Compared with WKZ, HSC had a higher prevalence of balloon-atrioseptostomy in transposition of the great arteries (83% vs 53%; P = .01) and more frequent preoperative focal injury (27% vs 6%; P = .06). Postoperatively, 30% of new multifocal injury could be attributed to postoperative low cardiac output syndrome, which was equally present at HSC and WKZ (38% vs 28%; P = .33). Postoperative focal injury was associated with intraoperative selective cerebral perfusion in CHD with arch obstruction at both sites (OR, 2.7). Compared with HSC, WKZ had more arch obstructions (62% vs 35%; P < .01) and a higher prevalence of new focal injury (36% vs 16%; P = .01). Brain injury is common in clinical cohorts of infants with critical CHD and related to practice approaches. This study confirms that the high prevalence of brain injury in critical CHD is a clinical concern and does not simply reflect the inclusion criteria of published research studies.
Identifiants
pubmed: 31451185
pii: S0022-3476(19)30869-8
doi: 10.1016/j.jpeds.2019.07.017
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
75-82.e2Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.