title: Risk factors for preoperative periventricular leukomalacia in term neonates with hypoplastic left heart syndrome are patient related.
abstract: BACKGROUND
  Preoperative brain injury is common in neonates with complex congenital heart disease. Increasing evidence suggests a complex interaction of prenatal and postnatal risk factors for development of brain white matter injury, called periventricular leukomalacia (PVL), in neonates with complex congenital heart disease. To date, there remains a limited understanding of the risk factors contributing to preoperative PVL in hypoplastic left heart syndrome (HLHS).
  
  
  METHODS
  Neonates with HLHS or HLHS variants from 3 prospective magnetic resonance imaging studies (2003-2010) were selected for this cohort. Preoperative brain magnetic resonance imaging was performed the morning of the surgery. Stepwise multilogistic regression of patient characteristics, mode of delivery (cesarean section vs vaginal), time of diagnosis (prenatal vs postnatal), HLHS subtypes, brain total maturation score, time to surgery, individual averaged daily preoperative blood gases, and complete blood cell count values was used to determine significant associations.
  
  
  RESULTS
  A total of 57 neonates with HLHS were born at 38.7 ± 2.3 weeks; 86% (49/57) had a prenatal diagnosis, with 31% (18/57) delivered by cesarean section. HLHS with aortic atresia (AA) was common in this cohort, 71% (41/57). Preoperative PVL was identified in 19% (11/57). Male patients with AA (P = .004) were at higher risk for PVL. Lower total brain maturation score was also identified as a strong predictor for preoperative PVL (P = .005).
  
  
  CONCLUSIONS
  In neonates with HLHS, nonmodifiable patient-related factors, including male sex with AA (lack of antegrade blood flow) and lower total brain maturation score, placed neonates at the greatest risk for preoperative white matter injury.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Division of Cardiology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, Calif. Electronic address: dgoff@llu.edu.
authors.forename: Donna A
authors.initials: DA
authors.lastname: Goff
authors.affiliation: Division of Biometrics Research, Merck & Co, Inc, North Wales, Pa.
authors.forename: David M
authors.initials: DM
authors.lastname: Shera
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tang
authors.affiliation: Department of Pediatrics, the Division of Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Natasha A
authors.initials: NA
authors.lastname: Lavin
authors.affiliation: Department of Pediatrics, the Division of Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Durning
authors.affiliation: Department of Anesthesia and Critical Care Medicine, the Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.affiliation: Department of Anesthesia and Critical Care Medicine, the Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.affiliation: Department of Anesthesia and Critical Care Medicine, the Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Department of Anesthesia and Critical Care Medicine, the Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.affiliation: Department of Surgery, and the Department of Radiology, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
mesh_terms: D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000601:surgery*; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000150:complications* / Q000453:epidemiology; D008297:Male; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors