Brain Maturity and Brain Injury in Newborns With Cyanotic Congenital Heart Disease

Patients with congenital heart disease (CHD) are at high risk for adverse neurodevelopmental outcomes. The aim of this work was to assess brain maturity and brain injury in newborns with cyanotic CHD using proton magnetic resonance spectroscopy (MRS). The study included 38 newborns with cyanotic CHD (study group) and 20 healthy full-term newborns (control group) matched together regarding gestational age and sex. Three-dimensional MRS showed that the mean ratio of N-acetylaspartate to choline (Ch) was significantly lower in newborns with cyanotic CHD (0.55 +/- A 0.08) compared with controls (0.67 +/- A 0.11) (p < 0.001). However, the mean ratio of lactate to Ch metabolite was significantly higher in the studied cases (0.14 +/- A 0.04) compared with controls (0.09 +/- A 0.04) (p < 0.001). The mean value for average diffusivity was 1.41 +/- A 0.06 in newborns with cyanotic CHD compared with 1.27 +/- A 0.07 in control newborns (p < 0.001), and the mean value for white-matter fractional anisotropy was 0.19 +/- A 0.03 in cyanotic newborns and 0.25 +/- A 0.08 in controls (p < 0.001). Newborns with cyanotic CHD are at increased risk of cerebral white matter injury as well as poor brain maturity. MRS provides a surrogate marker for early detection of such brain abnormalities.