A low incidence of preoperative neurosonographic abnormalities in neonates with heart defects.
BACKGROUND AND AIM
To investigate whether neonates with prenatally detected congenital heart defects (CHD) demonstrate cerebral abnormalities on early preoperative cranial ultrasound (CUS), compared to healthy neonates, and to measure brain structures to assess brain growth and development in both groups.


STUDY DESIGN, SUBJECTS AND OUTCOME MEASURES
Prospective cohort study with controls. Between September 2013 and May 2016 consecutive cases of prenatally detected severe isolated CHD were included. Neonatal CUS was performed shortly after birth, before surgery and in a healthy control group. Blinded images were reviewed for brain abnormalities and various measurements of intracranial structures were compared.


RESULTS
CUS was performed in 59 healthy controls and 50 CHD cases. Physiological CUS variants were present in 54% of controls and in 52% of CHD cases. Abnormalities requiring additional monitoring (both significant and minor) were identified in four controls (7%) and five CHD neonates (10%). Significant abnormalities were only identified in four CHD neonates (8%) and never in controls. A separate analysis of an additional 8 CHD neonates after endovascular intervention demonstrated arterial stroke in two cases that underwent balloon atrioseptostomy (BAS). Cerebral measurements were smaller in CHD neonates, except for the cerebrospinal fluid measurements, which were similar to the controls.


CONCLUSIONS
The prevalence of significant preoperative CUS abnormalities in CHD cases was lower than previously reported, which may be partially caused by a guarding effect of a prenatal diagnosis. Arterial stroke occurred only in cases after BAS. As expected, neonates with CHD display slightly smaller head size and cerebral growth.
['Jansen|Fenna A R|FAR|', 'Haak|Monique C|MC|', 'van Wesemael|Miriam S|MS|', 'Ten Harkel|A D J Derk-Jan|ADJD|', 'van Lith|Jan M M|JMM|', 'Blom|Nico A|NA|', 'Steggerda|Sylke J|SJ|']
D001921:Brain D016022:Case-Control Studies D005260:Female D006330:Heart Defects, Congenital D006801:Humans D015994:Incidence D007223:Infant D008297:Male D057234:Preoperative Period D011446:Prospective Studies D014463:Ultrasonography
Neonatal Congenital heart defects Cranial ultrasound Cerebral development