title: Minimizing the risk of preoperative brain injury in neonates with aortic arch obstruction.
abstract: OBJECTIVE
  To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers.
  
  
  METHODS
  From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Columbia (UBC), patients with aortic arch obstruction were selected and their imaging and clinical course reviewed.
  
  
  RESULTS
  Birth characteristics were comparable between UMCU (n = 33) and UCSF/UBC (n = 54). Patients had a hypoplastic aortic arch with either coarctation/interruption or hypoplastic left heart syndrome. In subjects with prenatal diagnosis, there was a significant difference in the prevalence of white matter injury (WMI) between centers (11 of 22 [50%] at UMCU vs 4 of 30 [13%] at UCSF/UBC; P < .01). Prenatal diagnosis was protective for WMI at UCSF/UBC (13% prenatal diagnoses vs 50% postnatal diagnoses; P < .01), but not at UMCU (50% vs 46%, respectively; P > .99). Differences in clinical practice between prenatally diagnosed subjects at UMCU vs UCSF/UBC included older age at surgery, less time spent in the intensive care unit, greater use of diuretics, less use of total parenteral nutrition (P < .01), and a greater incidence of infections (P = .01). In patients diagnosed postnatally, the prevalence of WMI was similar in the 2 centers (46% at UMCU vs 50% at UCSF/UBC; P > .99). Stroke prevalence was similar in the 2 centers regardless of prenatal diagnosis (prenatal diagnosis: 4.5% at Utrecht vs 6.7% at UCSF/UBC, P = .75; postnatal diagnosis: 9.1% vs 13%, respectively, P > .99).
  
  
  CONCLUSIONS
  Prenatal diagnosis can be protective for WMI, but this protection may be dependent on specific clinical management practices that differ across centers.
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Selma O
authors.initials: SO
authors.lastname: Algra
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: Haas
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Poskitt
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.affiliation: Department of Anesthesiology, Intensive Care, and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Antonius N J
authors.initials: AN
authors.lastname: Schouten
authors.affiliation: Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Nicolaas J G
authors.initials: NJ
authors.lastname: Jansen
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Azakie
authors.affiliation: Department of Pediatric Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Gandhi
authors.affiliation: Department of Pediatric Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Campbell
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Neurology , University of California San Francisco, San Francisco, CA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: McQuillen
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: l.s.devries@umcutrecht.nl.
authors.forename: Linda S
authors.initials: LS
authors.lastname: de Vries
mesh_terms: D001015:Aortic Arch Syndromes / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D056784:Leukoencephalopathies / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control*; D010289:Parenteral Nutrition, Total; D011296:Prenatal Diagnosis; D011300:Preoperative Care; D012307:Risk Factors