Brain volume and neurobehavior in newborns with complex congenital heart defects

J Pediatr. 2014 May;164(5):1121-1127.e1. doi: 10.1016/j.jpeds.2013.11.033. Epub 2013 Dec 22.


Objective: To investigate the relationship between tissue-specific alterations in brain volume and neurobehavioral status in newborns with complex congenital heart defects preoperatively.

Study design: Three-dimensional volumetric magnetic resonance imaging was used to calculate tissue-specific brain volumes and a standardized neurobehavioral assessment was performed to assess neurobehavioral status in 35 full-term newborns admitted to the hospital before cardiopulmonary bypass surgery. Multiple linear regression models were performed to evaluate relationships between neurobehavioral status and brain volumes.

Results: Reduced subcortical gray matter (SCGM) volume and increased cerebrospinal fluid (CSF) volume were associated with poor behavioral state regulation (SCGM, P = .04; CSF, P = .007) and poor visual orienting (CSF, P = .003). In cyanotic newborns, reduced SCGM was associated with higher overall abnormal scores on the assessment (P = .001) and poor behavioral state regulation (P = .04), and increased CSF volume was associated with poor behavioral state regulation (P = .02), and poor visual orienting (P = .02). Conversely, acyanotic newborns showed associations between reduced cerebellar volume and poor behavioral state regulation (P = .03).

Conclusion: Abnormal neurobehavior is associated with impaired volumetric brain growth before open heart surgery in infants with complex congenital heart defects. This study highlights a need for routine preoperative screening and early intervention to improve neurodevelopmental outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain / pathology*
  • Brain Injuries / diagnosis
  • Brain Injuries / etiology*
  • Cardiopulmonary Bypass
  • Female
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / pathology
  • Heart Defects, Congenital / psychology
  • Heart Defects, Congenital / surgery
  • Humans
  • Image Interpretation, Computer-Assisted
  • Imaging, Three-Dimensional
  • Infant Behavior*
  • Infant, Newborn
  • Linear Models
  • Magnetic Resonance Imaging
  • Male
  • Neurologic Examination
  • Neuropsychological Tests
  • Observer Variation
  • Organ Size
  • Preoperative Period
  • Prospective Studies
  • Single-Blind Method