Postnatal Brain Trajectories and Maternal Intelligence Predict Childhood Outcomes in Complex CHD

Vincent K Lee; Rafael Ceschin; William T Reynolds; Benjamin Meyers; Julia Wallace; Douglas Landsittel; Heather M Joseph; Daryaneh Badaly; J William Gaynor; Daniel Licht; Nathaniel H Greene; Ken M Brady; Jill V Hunter; Zili D Chu; Elisabeth A Wilde; R Blaine Easley; Dean Andropoulos; Ashok Panigrahy

doi:10.3390/jcm13102922

Postnatal Brain Trajectories and Maternal Intelligence Predict Childhood Outcomes in Complex CHD

J Clin Med. 2024 May 15;13(10):2922. doi: 10.3390/jcm13102922.

Authors

Vincent K Lee^{1

2}, Rafael Ceschin^{2

3}, William T Reynolds^{2

3}, Benjamin Meyers², Julia Wallace², Douglas Landsittel⁴, Heather M Joseph⁵, Daryaneh Badaly⁶, J William Gaynor⁷, Daniel Licht⁸, Nathaniel H Greene⁹, Ken M Brady¹⁰, Jill V Hunter^{11

12}, Zili D Chu^{11

12}, Elisabeth A Wilde^{11

12

13}, R Blaine Easley¹⁴, Dean Andropoulos^{14

15}, Ashok Panigrahy^{1

2

3}

Affiliations

¹ Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA.
² Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA.
³ Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA.
⁴ Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY 14260, USA.
⁵ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA.
⁶ Learning and Development Center, Child Mind Institute, New York, NY 10022, USA.
⁷ Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
⁸ Perinatal Pediatrics Institute, Children's National Hospital, Washinton, DC 20010, USA.
⁹ Anesthesiology, Oregon Health and Science University, Portland, OR 97239, USA.
¹⁰ Department of Pediatrics and Department of Anesthesiology, Lurie Children's Hospital, Northwestern University, Chicago, IL 60611, USA.
¹¹ Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA.
¹² H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
¹³ Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
¹⁴ Department of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX 77030, USA.
¹⁵ Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX 77030, USA.

Abstract

Objective: To determine whether early structural brain trajectories predict early childhood neurodevelopmental deficits in complex CHD patients and to assess relative cumulative risk profiles of clinical, genetic, and demographic risk factors across early development. Study Design: Term neonates with complex CHDs were recruited at Texas Children's Hospital from 2005-2011. Ninety-five participants underwent three structural MRI scans and three neurodevelopmental assessments. Brain region volumes and white matter tract fractional anisotropy and radial diffusivity were used to calculate trajectories: perioperative, postsurgical, and overall. Gross cognitive, language, and visuo-motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development and with the Wechsler Preschool and Primary Scale of Intelligence and Beery-Buktenica Developmental Test of Visual-Motor Integration. Multi-variable models incorporated risk factors. Results: Reduced overall period volumetric trajectories predicted poor language outcomes: brainstem ((β, 95% CI) 0.0977, 0.0382-0.1571; p = 0.0022) and white matter (0.0023, 0.0001-0.0046; p = 0.0397) at 5 years; brainstem (0.0711, 0.0157-0.1265; p = 0.0134) and deep grey matter (0.0085, 0.0011-0.0160; p = 0.0258) at 3 years. Maternal IQ was the strongest contributor to language variance, increasing from 37% at 1 year, 62% at 3 years, and 81% at 5 years. Genetic abnormality's contribution to variance decreased from 41% at 1 year to 25% at 3 years and was insignificant at 5 years. Conclusion: Reduced postnatal subcortical-cerebral white matter trajectories predicted poor early childhood neurodevelopmental outcomes, despite high contribution of maternal IQ. Maternal IQ was cumulative over time, exceeding the influence of known cardiac and genetic factors in complex CHD, underscoring the importance of heritable and parent-based environmental factors.

Keywords: MRI; congenital heart disease (CHD); diffusion tensor imaging; maternal IQ; neurodevelopmental deficits; regional brain volumes; structural brain trajectories; white matter tract.

Abstract

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