Recent advances in newborn heart surgery have greatly reduced brain injuries in infants with congenital heart disease, in response to a 20-year study by scientists at UCSF Benioff Kid’s Hospitals and British Columbia Kid’s Hospital (BCCH).
The study, begun in 2001 and published this month within the Journal of the American College of Cardiology, analyzed brain imaging data from 270 full-term UCSF and BCCH newborns with congenital heart disease (CHD) for changes in brain injuries before and after newborn cardiac surgery. The scientists confirmed that recent advances in surgical and clinical care that maintain a better postoperative blood pressure resulted in reducing brain injuries and higher possibilities of patient survival.
We were surprised to search out that advances in care over the past 7 years resulted in a transparent decline in brain injury linked to increasing the patient’s blood pressure following surgery. With advances in cardiac therapy and outcomes, our focus now could be helping these children thrive.”
Shabnam Peyvandi, MD, lead writer and pediatric cardiologist for UCSF Benioff Kid’s Hospitals
CHD, which refers to 1 or more abnormalities of an infant’s heart, impacts 40,000 newborns a 12 months within the U.S. It’s essentially the most common newborn birth defect. About 1 in 4 of those infants have critical CHD and require surgery in the primary month to first 12 months of life. Heart abnormalities include improperly functioning heart valves, a hole within the muscular wall separating the guts chambers, and malformations in the guts’s blood vessels, which may end up in altered patterns of blood flow. These anomalies reduce the flow of oxygen and nutrients to the brain and organs before birth, and may contribute to lifelong neurological and developmental disorders.
Recent approaches to watch brain health
To watch infant brain health for the study, UCSF and BCCH scientists used advanced magnetic resonance (MRI) brain imaging before and after heart surgery and consistently because the patient aged. The information was divided into 4 sequential stages, each containing five consecutive years of information. Within the fourth and final stage, which ran from 2016 to 2021, infants were maintained at higher post-surgical blood pressures than in previous groups. This resulted in an almost 20% reduction in post-surgical brain injuries in comparison with the primary group in 2001.
In the course of the course of this study, Peyvandi and the united states Benioff Kid’s Hospitals Pediatric Heart Center published multiple articles investigating brain development and white matter injuries – including a link between moderate-severe white matter injuries that led to delays in childhood motor function – that opened the door to improving long run developmental outcomes by decreasing early brain injuries.
“Taken together, these findings underscore the importance of tracking brain injury and implementing changes to scale back occurrences that may improve outcomes,” said Patrick McQuillen, MD, senior writer and professor of Pediatrics, UCSF Benioff Kid’s Hospitals. “Based on this research and others, several leading heart centers have incorporated brain imaging into routine clinical practice.”
Work from this group has directly informed the creation of novel clinical programs to watch and protect the brain in fetuses, newborns and kids with CHD, including the Healthy Hearts & Minds Program and the Neonatal Cardiovascular Center of Excellence Growth and Neurodevelopment (GRAND) program that comes with developmental care on the inpatient setting for newborns with critical CHD.
Other UCSF authors include Duan Xu, PHD, A. James Barkovich, MD, Dawn Gano, MD, MAS, V. Mohan Reddy, MD .
Source:
University of California – San Francisco
Journal reference:
Peyvandi, S., et al. (2023) Declining Incidence of Postoperative Neonatal Brain Injury in Congenital Heart Disease. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2022.10.029.