title: Brain volume and neurobehavior in newborns with complex congenital heart defects.
abstract: OBJECTIVE
  To investigate the relationship between tissue-specific alterations in brain volume and neurobehavioral status in newborns with complex congenital heart defects preoperatively.
  
  
  METHODS
  Three-dimensional volumetric magnetic resonance imaging was used to calculate tissue-specific brain volumes and a standardized neurobehavioral assessment was performed to assess neurobehavioral status in 35 full-term newborns admitted to the hospital before cardiopulmonary bypass surgery. Multiple linear regression models were performed to evaluate relationships between neurobehavioral status and brain volumes.
  
  
  RESULTS
  Reduced subcortical gray matter (SCGM) volume and increased cerebrospinal fluid (CSF) volume were associated with poor behavioral state regulation (SCGM, P = .04; CSF, P = .007) and poor visual orienting (CSF, P = .003). In cyanotic newborns, reduced SCGM was associated with higher overall abnormal scores on the assessment (P = .001) and poor behavioral state regulation (P = .04), and increased CSF volume was associated with poor behavioral state regulation (P = .02), and poor visual orienting (P = .02). Conversely, acyanotic newborns showed associations between reduced cerebellar volume and poor behavioral state regulation (P = .03).
  
  
  CONCLUSIONS
  Abnormal neurobehavior is associated with impaired volumetric brain growth before open heart surgery in infants with complex congenital heart defects. This study highlights a need for routine preoperative screening and early intervention to improve neurodevelopmental outcomes.
authors.affiliation: Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada; Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Mallory
authors.initials: M
authors.lastname: Owen
authors.affiliation: Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Shevell
authors.affiliation: Department of Cardiology, Children's National Medical Center, Washington, DC.
authors.forename: Mary
authors.initials: M
authors.lastname: Donofrio
authors.affiliation: Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada; School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.
authors.forename: Annette
authors.initials: A
authors.lastname: Majnemer
authors.affiliation: Department of Biostatistics and Informatics, Children's National Medical Center, Washington, DC.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Marine
authors.initials: M
authors.lastname: Bouyssi-Kobar
authors.affiliation: Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Iordanis
authors.initials: I
authors.lastname: Evangelou
authors.affiliation: Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Dena
authors.initials: D
authors.lastname: Freeman
authors.affiliation: Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA.
authors.forename: Neil
authors.initials: N
authors.lastname: Weisenfeld
authors.affiliation: Advanced Pediatric Brain Imaging Research Laboratory, Diagnostic Imaging and Radiology/Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery, McGill University Health Center, Montréal, Québec, Canada. Electronic address: climpero@childrensnational.org.
authors.forename: Catherine
authors.initials: C
authors.lastname: Limperopoulos
mesh_terms: D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000175:diagnosis / Q000209:etiology*; D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000473:pathology / Q000523:psychology / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018730:Infant Behavior; D007231:Infant, Newborn; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D015588:Observer Variation; D009929:Organ Size; D057234:Preoperative Period; D011446:Prospective Studies; D016037:Single-Blind Method