The association between flow and oxygenation and cortical development in fetuses with congenital heart defects using a brain‐age prediction algorithm

Prenatal Diagnosis, vol. 41, pp. 43–51

Abstract

OBJECTIVES: Presumably, changes in fetal circulation contribute to the delay in maturation of the cortex in fetuses with congenital heart defect (CHD). The aim of the current study is to analyze fetal brain development based on hemodynamic differences, using novel brain-age prediction software. METHODS: We have performed detailed neurosonography, including acquiring 3D volumes, prospectively in cases with isolated CHD from 20 weeks onwards. An algorithm that assesses the degree of fetal brain-age automatically was used to compare CHD cases to controls. We stratified CHD cases according to flow and oxygenation profiles by lesion physiology and performed subgroup analyses. RESULTS: A total of 616 ultrasound volumes of 162 CHD cases and 75 controls were analyzed. Significant differences in maturation of the cortex were observed in cases with normal blood flow toward the brain (-3.8 days, 95%CI [-5.5; -2.0], P = <.001) and low (-4.0 days, 95% CI [-6.7; -1.2] P = <.05; hypoplastic left heart syndrome[HLHS]) and mixed (-4.4 days, 95%CI [-6.4; -2.5] p = <.001) oxygen saturation in the ascending aorta (TGA) and in cardiac mixing (eg, Fallot) cases. CONCLUSION: The current study shows significant delay in brain-age in TGA and Fallot cases as compared to control cases. However, the small differences found in this study questions the clinical relevance.

Authors 10

1. Sheila M. P. Everwijn corresponding Aachen Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands Department of Obstetrics and Prenatal Diagnosis

   Leiden University Medical Center

   Affiliation as printed

   Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands

   Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands

2. Ana I. L. Namburete

   University of Oxford

   Affiliation as printed

   Department of Engineering Science, Institute of Biomedical Engineering University of Oxford Oxford UK

   Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK

3. Nan van Geloven Aachen Department of Biomedical Data Sciences Section Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands Section Medical Statistics and Bioinformatics

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Section Medical Statistics and Bioinformatics Leiden University Medical Center Leiden The Netherlands

   Department of Biomedical Data Sciences, Section Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

4. Fenna A. R. Jansen Aachen Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands Department of Obstetrics and Prenatal Diagnosis

   Leiden University Medical Center

   Affiliation as printed

   Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands

   Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands

5. Aris T. Papageorghiou

   University of Oxford

   Affiliation as printed

   Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK

   Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK

6. Aalbertine K. K. Teunissen Aachen Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands Department of Obstetrics and Prenatal Diagnosis

   Leiden University Medical Center

   Affiliation as printed

   Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands

   Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands

7. Lieke Rozendaal Aachen Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands Department of Pediatric Cardiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands

   Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands

8. Nico A. Blom Aachen Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands Department of Pediatric Cardiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands

   Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands

9. Jan MM van Lith Aachen Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands Department of Obstetrics and Prenatal Diagnosis

   Leiden University Medical Center

   Affiliation as printed

   Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands

   Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands

10. Monique C. Haak Aachen Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands Department of Obstetrics and Prenatal Diagnosis

    Leiden University Medical Center

    Affiliation as printed

    Department of Obstetrics and Prenatal Diagnosis Leiden University Medical Center Leiden The Netherlands

    Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands