Historical Trends in Neonatal Brain Injuries Among Patients With Complex Congenital Heart Disease

White matter injury (WMI) is a complication both before and after neonatal cardiac surgery which negatively affects developmental outcomes in newborns with complex congenital heart disease (cCHD).  In a study presented at the American College of Cardiology 71st Annual Scientific Session & Expo, researchers reported findings from a 20-year prospective study aiming to define temporal trends of WMI and risk factors in newborns with cCHD. They concluded that “post-operative but not pre-operative WMI rates have declined over time despite increased complexity of patients.”

The authors, led by primary investigator Shabnam Peyvandi, theorized that “an improved hemodynamic state in the first 24 hours post-op may contribute to this decline.” However, they noted that “perinatal and pre-operative periods continue to be high risk for WMI in cCHD.”

The study included a total of 270 newborns with cCHD from 2001 to 2021, excluding prematurity and genetic-related CHD. A brain MRI was used to assess WMI before and after surgery, and multivariable regression models were used to estimate the probability of WMI over four consecutive “epoch” time periods.

In the study’s sample of 466 MRIs (pre-operative = 246; post-operative = 220), the investigators observed more single ventricles in the latest epoch compared to the earliest. As noted, there was no significant variation in the probability of pre-op WMI over the period; however, the authors reported a significant decline in probability of post-op WMI after a for site, cardiac group, and age at time of MRI (95% confidence interval [CI] 0.5–22%; p = 0.05). Additionally, cardiopulmonary bypass and cross-clamp time increased over the period. Finally, the lowest systolic, diastolic, and mean blood pressures in a 24-hour post-operative period were significantly more prevalent in the latest epoch versus earlier epochs.