SES, clinical factors trump brain MRI in predicting long-term neurodevelopment in CHD infants

In infants with congenital heart disease (CHD), the perioperative clinical course and socioeconomic status (SES) appear to be better predictors of long-term neurodevelopmental outcomes than conventional neonatal brain magnetic resonance imaging (MRI), a new study has found.

Researchers conducted a prospective cohort analysis of 57 term infants receiving cardiopulmonary bypass for CHD. All participants underwent perioperative cerebral MRI screening, whose images were assessed by a trained professional to produce a Brain Injury Severity (BIS) score for each patient.

The study outcome was neurodevelopment, assessed using the 3rd edition of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) at a median 6.0 years of age.

Perioperatively, more than a quarter (26.3 percent; n=15) of patients had moderate to severe brain injury, as classified by BIS. Meanwhile, total, verbal, and performance IQ of CHD children at 6 years did not differ from normative means. Nevertheless, processing speed, motor score, and motor coordination were all significantly worse in the CHD cohort, while visual perception was better.

Multiple linear regression analysis revealed that the log of hospital stay (B, 19.39; p=0.004) and SES (B, 2.99; p<0.001) were both significantly associated with total IQ score measured at preschool age. In contrast MRI factors, such as postoperative total brain volume (p=0.46) and cumulative BIS score (p=0.57) were not.

“These findings underline the importance of early therapeutic support for children with low SES and long hospital stay,” the researchers said.