Clinical Factors Associated with Cerebral Metabolism in Term Neonates with Congenital Heart Disease

Overview

Journal J Pediatr

Specialty Pediatrics

Date 2017 Jan 23

PMID 28109537

Citations 11

Authors

Anna Lonyai Harbison

Jodie K Votava-Smith

Sylvia Del Castillo

S Ram Kumar

Vince Lee

Vincent Schmithorst

Hollie A Lai

Sharon ONeil

Stefan Bluml

Lisa Paquette

Ashok Panigrahy

Affiliations

Soon will be listed here.

Abstract

Objective: To determine associations between patient and clinical factors with postnatal brain metabolism in term neonates with congenital heart disease (CHD) via the use of quantitative magnetic resonance spectroscopy.

Study Design: Neonates with CHD were enrolled prospectively to undergo pre- and postoperative 3T brain magnetic resonance imaging. Short-echo single-voxel magnetic resonance spectroscopy of parietal white matter was used to quantify metabolites related to brain maturation (n-acetyl aspartate, choline, myo- inositol), neurotransmitters (glutamate and gamma-aminobutyric acid), energy metabolism (glutamine, citrate, glucose, and phosphocreatine), and injury/apoptosis (lactate and lipids). Multivariable regression was performed to search for associations between (1) patient-specific/prenatal/preoperative factors with concurrent brain metabolism and (2) intraoperative and postoperative factors with postoperative brain metabolism.

Results: A total of 83 magnetic resonance images were obtained on 55 subjects. No patient-specific, prenatal, or preoperative factors associated with concurrent metabolic brain dysmaturation or elevated lactate could be identified. Chromosome 22q11 microdeletion and age at surgery were predictive of altered concurrent white matter phosphocreatine (P < .0055). The only significant intraoperative association found was increased deep hypothermic circulatory arrest time with reduced postoperative white matter glutamate and gamma-aminobutyric acid (P < .0072). Multiple postoperative factors, including increased number of extracorporeal membrane oxygenation days (P < .0067), intensive care unit, length of stay (P < .0047), seizures in the intensive care unit (P < .0009), and home antiepileptic use (P < .0002), were associated with reduced postoperative white matter n-acetyl aspartate.

Conclusion: Multiple postoperative factors were found to be associated with altered brain metabolism in term infants with CHD, but not patient-specific, preoperative, or intraoperative factors.

Citing Articles

Validation of a Paralimbic-Related Subcortical Brain Dysmaturation MRI Score in Infants with Congenital Heart Disease.

Reynolds W, Votava-Smith J, Gabriel G, Lee V, Rajagopalan V, Wu Y J Clin Med. 2024; 13(19).

PMID: 39407833 PMC: 11476423. DOI: 10.3390/jcm13195772.

Altered In Utero Metabolic Brain Trajectories in CHD: Going Beyond Fetal Brain Structure and Physiology.

Panigrahy A, Bluml S, Rajagopalan V J Am Coll Cardiol. 2023; 82(16):1624-1627.

PMID: 37821173 PMC: 11136159. DOI: 10.1016/j.jacc.2023.08.039.

Preoperative serum cortisone levels are associated with cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: new evidence from human populations and mice.

Ma S, Liu Y, Cun Y, Wang Q, Fu M, Wu K World J Pediatr. 2023; 20(2):173-184.

PMID: 37737505 PMC: 10884142. DOI: 10.1007/s12519-023-00754-2.

Clinical factors associated with microstructural connectome related brain dysmaturation in term neonates with congenital heart disease.

Votava-Smith J, Gaesser J, Harbison A, Lee V, Tran N, Rajagopalan V Front Neurosci. 2022; 16:952355.

PMID: 36466162 PMC: 9717392. DOI: 10.3389/fnins.2022.952355.

Preoperative Care of Neonates With Congenital Heart Disease.

Tran N, Tran M, Lemus R, Woon J, Lopez J, Dang R Neonatal Netw. 2022; 41(4):200-210.

PMID: 35840337 PMC: 10233459. DOI: 10.1891/NN-2021-0028.

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