Congenital heart disease: the timing of brain injury

Congenital heart disease: the timing of brain injury

Infants with severe congenital heart disease are at risk of neurodevelopmental impairments later in life. It has been hypothesized that hemodynamic alterations are a major contributor to these impairments. This thesis aims to gain more insight into the timing of brain injury by assessing hemodynamic characteristics regarding cerebral circulation or brain function. First, we systematically reviewed all available literature on prenatal and postnatal cerebral findings and neurodevelopmental outcome. Both the prenatal period and the early postnatal period seem to play a major role in neurodevelopmental outcome in infants with severe congenital heart disease. Second, we conducted several retrospective and prospective observational studies and found that fetuses with severe congenital heart disease often have abnormal Doppler flow profiles. Neonates with severe congenital heart disease often have low cerebral oxygen saturation, abnormal background patterns on amplitude-integrated electro-encephalography and 15% have subclinical epileptic activity during the first 72 hours after birth. This thesis concludes with the first longitudinal study that assesses the association between prenatal Doppler flow profiles, postnatal preoperative, intraoperative and postoperative cerebral oxygen saturation and short-term neurodevelopmental outcome. The prenatal period seems to play a major role in neurodevelopmental outcome. Furthermore, infants with abnormal findings both prenatally and postnatally have a nine-fold increased risk of abnormal short-term neurodevelopmental outcome. Future studies should focus on preventative strategies, such as neuroprotective therapy or fetal cardiac surgery.

Dissertation: http://hdl.handle.net/11370/55206db2-dd48-447f-b579-e3fbd02f7075