Prenatal and Preoperative Cerebral Findings and Their Relation With NDO

Study (First Author, Journal, Year of Publication)Study Design, No. InfantsCHDAge at NDO Testing, MoMethodsOutcomeFindings (Compared With Healthy Controls and/or Reference Values, Unless Otherwise Stated)Relation
Hahn et al, Ultrasound Obstet Gynecol, 2016Retrospective study, N = 133SVA14Ultrasound (Doppler and biometry)BSID IIMDI 88.5 ± 16.6 and PDI 76.4 ± 19.8±
First MCA-PI negatively associated with PDI
HC/AC negatively associated with PDI
Zeng et al, Ultrasound Obstet Gynecol, 2015Case-control study, N = 112/112Mixed12Ultrasound (three dimensional, Doppler)BSID IILower MDI (85.2 vs 99.1) and PDI (72.8 vs 99.4)±
No correlation between MCA-PI and NDO
Total intracranial flow index positively correlated with PDI and MDI
Williams et al, Am Heart J, 2013Cohort study, N = 134SVA14Ultrasound (Doppler)BSID IIMDI 88.5 ± 16.6 and PDI 76.4 ± 19.8+
62% PDI < 85 and 35% MDI < 85
MCA-PI correlated negatively with PDI but not with MDI
MCA-PI < −2.0, on average, with 11-point-higher PDI scores compared with MCA-PI > −2.0 (84.7 vs 73.6)
Latal et al, Dev Med Child Neurol, 2015Cohort study, N = 77Mixed12HUSBSID IIMDI 89 (49–107) and PDI 69 (49–113)
Isolated CHD: MDI 91 (50–107) and PDI 70 (49–113)
No association between brain injury on ultrasound and NDO
Masoller et al, Ultrasound Obstet Gynecol, 2016Case-control study, N = 58/58Mixed6MRIBayley IIILower cognitive (91 vs 103), language (97 vs 108), motor (86 vs 100), social-emotional (85 vs 106), and adaptive (89 vs 97) score+
Average Bayley III score associated with total blood volume, left and right singulate depth, frontal Ino/Cho ratio, and NAA/Cho ratio
Andropoulos et al, Paediatr Anaesth, 2014Retrospective study, N = 59Mixed12MRIBayley IIIComposite scores: cognitive 102 ± −13.3, language 87.8 ± −12.5, motor 89.6 ± 14.1±
Preoperative brain injury not associated with NDO
Preoperative rcSo2 values associated with cognitive and motor score
Beca et al, Circulation, 2013Cohort study, N = 153Mixed3 and 24MRIBayley IIIComposite scores: cognitive 94 ± 15, language 94 ± 16, motor 97 ± 12+
Delay in maturation of the posterior limb of the internal capsule on the first MRI associated with lower motor scores
Lower brain maturity associated with reduced performance on all domains
Amplitude-integrated EEG
Gunn et al, Ann Thorac Surg, 2012Cohort study, N = 39SVA24aEEGBayley IIIComposite scores: cognitive 92.4 ± 13.5, language 94.3 ± 17.7, motor 93.8 ± 10.6±
Seizures associated with mortality but not associated with NDO
Recovery of background pattern within 48 h: 14 points increase in motor score
Gunn et al, Intensive Care Med, 2012Cohort study, N = 150Mixed48aEEGBayley IIIComposite scores: cognitive 93.2 ± 13.7, language 93.5 ± 16.2, motor 96.7 ± 12.7
Preoperative background pattern not associated with NDO
Combination of techniques
Andropoulos et al, Ann Thorac Surg, 2012Cohort study, N = 30TGA12NIRSBayley IIIComposite scores: cognitive 104.8 ± 15, language 90.0 (83.0–94.0), motor 92.3 ± 14.2+
MRILower preoperative rcSo2 associated with lower cognitive score
Preoperative brain injury associated with lower language score
Preoperative brain injury, lower preoperative rcSo2, associated with lower motor score
Williams et al, Ultrasound Obstet Gynecol, 2012Pilot study, N = 13Mixed18Ultrasound (Doppler)Bayley IIIComposite scores: cognitive 95, language 84, motor 87+
EEGLanguage and motor scores in HLHS and TOF >1 SD below population mean
MCA-PI correlated positively with cognitive scores
EEG left frontal polar and left frontal β power correlated positively with cognitive scores
MCA-PI correlated positively with neonatal EEG left frontal polar and left frontal β power
Toet et al, Exp Brain Res, 2005Cohort study, N = 20TGA30NIRSBSID IIrcSo2 ≤ 35%: MDI 97 and PDI 95±
aEEGrcSo2 > 35%: MDI 101 and PDI 106
Low rcSo2 associated with lower MDI and PDI
Robertson et al, Cardiol Young, 2004Cohort study, N = 35Mixed12BSID IIBSID IIPreoperatively: MDI 103 ± 5 (all infants within normal range) and PDI 99 ± 8 (2 infants below 80)
EEG12 mo follow-up: MDI 94 ± 13 and PDI 89 ± 20
Transcranial Doppler57% both MDI and PDI in normal range
No association between EEG abnormalities, reduced cerebral blood flow, and NDO
  • HC/AC, head circumference/abdominal circumference; SVA, single ventricle anomaly; TOF, tetralogy of Fallot.