Abstract：
OBJECTIVE: To examine the relationship between perioperative brain injury and neurodevelopment during early childhood in patients with severe congenital heart disease (CHD).
METHODS: One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up.
RESULTS: Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = -0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = -0.35).
CONCLUSIONS: Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.
METHODS: One hundred and seventy children with CHD and born at term who required cardiopulmonary bypass surgery in the first 6 weeks after birth were recruited from 3 European centers and underwent preoperative and postoperative brain MRIs. Uniform description of imaging findings was performed and an overall brain injury score was created, based on the sum of the worst preoperative or postoperative brain injury subscores. Motor and cognitive outcomes were assessed with the Bayley Scales of Infant and Toddler Development Third Edition at 12 to 30 months of age. The relationship between brain injury score and clinical outcome was assessed using multiple linear regression analysis, adjusting for CHD severity, length of hospital stay (LOS), socioeconomic status (SES), and age at follow-up.
RESULTS: Neither the overall brain injury score nor any of the brain injury subscores correlated with motor or cognitive outcome. The number of preoperative white matter lesions was significantly associated with gross motor outcome after correction for multiple testing (P = .013, β = -0.50). SES was independently associated with cognitive outcome (P < .001, β = 0.26), and LOS with motor outcome (P < .001, β = -0.35).
CONCLUSIONS: Preoperative white matter lesions appear to be the most predictive MRI marker for adverse early childhood gross motor outcome in this large European cohort of infants with severe CHD. LOS as a marker of disease severity, and SES influence outcome and future intervention trials need to address these risk factors.
摘要：
目的：探讨重症先天性心脏病（CHD）患者围手术期脑损伤与早期神经发育的关系。
方法：从3个欧洲中心招募了170名足月出生的CHD儿童，这些儿童在出生后的前6周内需要进行体外循环手术，并进行了术前和术后脑MRI检查。对影像学发现进行统一描述，并创建总体脑损伤评分，基于最差的术前或术后脑损伤子评分的总和。使用Bayley婴儿和幼儿发展量表第三版评估12至30个月大的运动和认知结果。使用多元线性回归分析评估脑损伤评分与临床结果之间的关系，调整CHD严重程度，住院时间（LOS），社会经济地位(SES)，和随访年龄。
结果：总体脑损伤评分和任何脑损伤子评分均与运动或认知结果无关。术前白质病变的数量与多项测试校正后的粗大运动结果显着相关（p=0.013，β=-0.50）。SES与认知结果独立相关（p<0.001，β=0.26），和LOS与运动结果（p<0.001，β=-0.35）。
结论：术前白质病变似乎是在这一大型欧洲重度CHD婴儿队列中儿童早期粗大运动不良结局的最具预测性的MRI标志物。LOS作为疾病严重程度的标志，和SES影响结局,未来的干预试验需要解决这些风险因素.
方法：从3个欧洲中心招募了170名足月出生的CHD儿童，这些儿童在出生后的前6周内需要进行体外循环手术，并进行了术前和术后脑MRI检查。对影像学发现进行统一描述，并创建总体脑损伤评分，基于最差的术前或术后脑损伤子评分的总和。使用Bayley婴儿和幼儿发展量表第三版评估12至30个月大的运动和认知结果。使用多元线性回归分析评估脑损伤评分与临床结果之间的关系，调整CHD严重程度，住院时间（LOS），社会经济地位(SES)，和随访年龄。
结果：总体脑损伤评分和任何脑损伤子评分均与运动或认知结果无关。术前白质病变的数量与多项测试校正后的粗大运动结果显着相关（p=0.013，β=-0.50）。SES与认知结果独立相关（p<0.001，β=0.26），和LOS与运动结果（p<0.001，β=-0.35）。
结论：术前白质病变似乎是在这一大型欧洲重度CHD婴儿队列中儿童早期粗大运动不良结局的最具预测性的MRI标志物。LOS作为疾病严重程度的标志，和SES影响结局,未来的干预试验需要解决这些风险因素.
