Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes
Background Infants with congenital heart disease require early lifesaving heart surgery, which increases risk for brain injury and neurodevelopmental delay. Cerebral microhemorrhages (CMH) are frequently seen after surgery, but whether they are benign or constitute injury is unknown. Methods and Res...
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.035359 |
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| author | Kristen N. Andersen Sicong Yao Brian R. White Marin Jacobwitz Jake Breimann Jharna Jahnavi Alexander Schmidt Wesley B. Baker Tiffany S. Ko J. William Gaynor Arastoo Vossough Rui Xiao Daniel J. Licht Evelyn K. Shih |
| author_facet | Kristen N. Andersen Sicong Yao Brian R. White Marin Jacobwitz Jake Breimann Jharna Jahnavi Alexander Schmidt Wesley B. Baker Tiffany S. Ko J. William Gaynor Arastoo Vossough Rui Xiao Daniel J. Licht Evelyn K. Shih |
| author_sort | Kristen N. Andersen |
| collection | DOAJ |
| description | Background Infants with congenital heart disease require early lifesaving heart surgery, which increases risk for brain injury and neurodevelopmental delay. Cerebral microhemorrhages (CMH) are frequently seen after surgery, but whether they are benign or constitute injury is unknown. Methods and Results One hundred ninety‐two infants with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were evaluated with pre‐ (n=183) and/or postoperative (n=162) magnetic resonance imaging. Perioperative risk factors for CMH and neurodevelopmental outcomes were analyzed using linear regression. Eighteen‐month neurodevelopmental outcomes were assessed in a subset of patients (n=82). The most common congenital heart disease subtypes were hypoplastic left heart syndrome (37%) and transposition of the great arteries (33%). Forty‐two infants (23%) had CMH present on magnetic resonance imaging presurgery and 137 infants (85%) postsurgery. We found no significant risk factors for preoperative CMH. In multivariable analysis, neurodevelopmental duration (P<0.0001), use of extracorporeal membrane oxygenation support (P<0.0005), postoperative seizure(s) (P=0.02), and lower birth weight (P=0.03) were associated with new or worsened CMH postoperatively. A higher CMH number was associated with lower motor scores (P=0.01) at 18 months. Conclusions CMH are common imaging findings in infants with congenital heart disease, particularly after cardiopulmonary bypass conferring adverse impact on neurodevelopmental outcomes at 18 months. Longer duration of cardiopulmonary bypass and extracorporeal membrane oxygenation use demonstrated greatest risk for developing CMH. However, the presence of CMH on preoperative scans indicates yet unidentified nonperioperative risk factors. Neuroprotective strategies to mitigate CMH risk may improve neurodevelopmental outcomes in this vulnerable population. |
| format | Article |
| id | doaj-art-c26b9d4552a44ad7bd6a2f0cbd91ae45 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-c26b9d4552a44ad7bd6a2f0cbd91ae452025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.123.035359Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental OutcomesKristen N. Andersen0Sicong Yao1Brian R. White2Marin Jacobwitz3Jake Breimann4Jharna Jahnavi5Alexander Schmidt6Wesley B. Baker7Tiffany S. Ko8J. William Gaynor9Arastoo Vossough10Rui Xiao11Daniel J. Licht12Evelyn K. Shih13Department of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Biostatistics Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Cardiology Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Anesthesiology and Critical Care Medicine Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Surgery, Division of Cardiothoracic Surgery Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Radiology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Biostatistics Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USADepartment of Pediatrics, Division of Neurology Children’s Hospital of Philadelphia Philadelphia PA USABackground Infants with congenital heart disease require early lifesaving heart surgery, which increases risk for brain injury and neurodevelopmental delay. Cerebral microhemorrhages (CMH) are frequently seen after surgery, but whether they are benign or constitute injury is unknown. Methods and Results One hundred ninety‐two infants with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were evaluated with pre‐ (n=183) and/or postoperative (n=162) magnetic resonance imaging. Perioperative risk factors for CMH and neurodevelopmental outcomes were analyzed using linear regression. Eighteen‐month neurodevelopmental outcomes were assessed in a subset of patients (n=82). The most common congenital heart disease subtypes were hypoplastic left heart syndrome (37%) and transposition of the great arteries (33%). Forty‐two infants (23%) had CMH present on magnetic resonance imaging presurgery and 137 infants (85%) postsurgery. We found no significant risk factors for preoperative CMH. In multivariable analysis, neurodevelopmental duration (P<0.0001), use of extracorporeal membrane oxygenation support (P<0.0005), postoperative seizure(s) (P=0.02), and lower birth weight (P=0.03) were associated with new or worsened CMH postoperatively. A higher CMH number was associated with lower motor scores (P=0.01) at 18 months. Conclusions CMH are common imaging findings in infants with congenital heart disease, particularly after cardiopulmonary bypass conferring adverse impact on neurodevelopmental outcomes at 18 months. Longer duration of cardiopulmonary bypass and extracorporeal membrane oxygenation use demonstrated greatest risk for developing CMH. However, the presence of CMH on preoperative scans indicates yet unidentified nonperioperative risk factors. Neuroprotective strategies to mitigate CMH risk may improve neurodevelopmental outcomes in this vulnerable population.https://www.ahajournals.org/doi/10.1161/JAHA.123.035359cardiopulmonary bypasscerebral microhemorrhagecongenital heart diseaseneurodevelopmental outcomes |
| spellingShingle | Kristen N. Andersen Sicong Yao Brian R. White Marin Jacobwitz Jake Breimann Jharna Jahnavi Alexander Schmidt Wesley B. Baker Tiffany S. Ko J. William Gaynor Arastoo Vossough Rui Xiao Daniel J. Licht Evelyn K. Shih Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiopulmonary bypass cerebral microhemorrhage congenital heart disease neurodevelopmental outcomes |
| title | Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes |
| title_full | Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes |
| title_fullStr | Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes |
| title_full_unstemmed | Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes |
| title_short | Cerebral Microhemorrhages in Children With Congenital Heart Disease: Prevalence, Risk Factors, and Association With Neurodevelopmental Outcomes |
| title_sort | cerebral microhemorrhages in children with congenital heart disease prevalence risk factors and association with neurodevelopmental outcomes |
| topic | cardiopulmonary bypass cerebral microhemorrhage congenital heart disease neurodevelopmental outcomes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.035359 |
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