Abstract 17713: Fetal Brain Volume as a Predictor of Postnatal Brain Injury in Neonates With Critical Congenital Heart Disease
Objective: Pre-operative brain injury is reported in 30% of neonates with critical congenital heart disease (CHD), appearing in the form of white matter injury (WMI) or stroke. Compared to controls, fetuses with CHD have a smaller total brain volume (TBV) measurable in the third trimester. The relationship between fetal onset of delayed brain development and the risk of pre-operative brain injury is unknown. We hypothesize that a lower fetal TBV predicts the presence and severity of pre-operative brain injury.
Methods: Longitudinal fetal and pre-operative neonatal brain magnetic resonance imaging (MRI) studies were evaluated in term newborns with CHD. Fetal MRI was performed in the third trimester and TBV was calculated by manual segmentation and excluded extra-axial and ventricular volumes. Neonatal MRI was assessed for the presence and severity of pre-operative brain injury (WMI and stroke). TBV was compared between those with (n= 5) and without brain injury (n= 7) and stratified based on brain injury severity (BIS) score. Analysis included descriptive statistics, Student t test and non-parametric test for trends.
Results: 25 subjects had both fetal and neonatal imaging performed, of which 12 were processed and analyzed. Fetal imaging was performed at a median gestational age of 32.3 weeks (IQR 31.3-33.4) with no difference between those with neonatal pre-operative brain injury (32 wks, IQR 32-33) and those without (32.7 wks, IQR 31.7-34). Subjects with brain injury had a lower mean fetal TBV (187.8 cm3, 95%CI: 156.9-218.7) compared to those without injury (225.2 cm3, 95%CI: 189.8-260.6, p= 0.08), Figure 1. Patients with the most severe brain injury (BIS 3) had the lowest mean TBV (176.4 cm3, SD 26.6) with a trend towards lower TBV with increasing severity of brain injury (p= 0.06).
Conclusions: Fetal TBV in the third trimester may be a predictor of risk for postnatal pre-operative brain injury in those with CHD. Further analysis with a larger sample size will be performed.
Author Disclosures: S. Peyvandi: None. J. Lau: None. T. Kingdom: None. D. Xu: None. A. Moon-Grady: None. M. Seed: None. S. Miller: None. H. Kim: None. P. McQuillen: None.
- © 2016 by American Heart Association, Inc.