Skip to main content
×
Home

Infection and white matter injury in infants with congenital cardiac disease

  • Hannah C. Glass (a1) (a2), Chelsea Bowman (a1), Vann Chau (a3), Alisha Moosa (a3), Adam L. Hersh (a2), Andrew Campbell (a4), Kenneth Poskitt (a5), Anthony Azakie (a6), A. James Barkovich (a7), Steven P. Miller (a3) and Patrick S. McQuillen (a2)...
Abstract
Abstract

More than 60% of newborns with severe congenital cardiac disease develop perioperative brain injuries. Known risk factors include: pre-operative hypoxemia, cardiopulmonary bypass characteristics, and post-operative hypotension. Infection is an established risk factor for white matter injury in premature newborns. In this study, we examined term infants with congenital cardiac disease requiring surgical repair to determine whether infection is associated with white matter injury. Acquired infection was specified by site – bloodstream, pneumonia, or surgical site infection – according to strict definitions. Infection was present in 23 of 127 infants. Pre- and post-operative imaging was evaluated for acquired injury by a paediatric neuroradiologist. Overall, there was no difference in newly acquired post-operative white matter injury in infants with infection (30%), compared to those without (31%). When stratified by anatomy, infants with transposition of the great arteries, and bloodstream infection had an estimated doubling of risk of white matter injury that was not significant, whereas those with single ventricle anatomy had no apparent added risk. When considering only infants without stroke, the estimated association was higher, and became significant after adjusting for duration of inotrope therapy. In this study, nosocomial infection was not associated with white matter injury. Nonetheless, when controlling for risk factors, there was an association between bloodstream infection and white matter injury in selected sub-populations. Infection prevention may have the potential to mitigate long-term neurologic impairment as a consequence of white matter injury, which underscores the importance of attention to infection control for these patients.

Copyright
Corresponding author
Correspondence to: H. C. Glass, MDCM, MAS, FRCPC, Department of Neurology, University of California San Francisco, Box 0663, 521 Parnassus Avenue, C-215, San Francisco, California 94143-0663, United States of America. Tel: 415 514 3277; Fax: 415 502 5821; E-mail: Hannah.Glass@ucsf.edu
References
Hide All
1.Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 18901900.
2.Samanek M. Congenital heart malformations: prevalence, severity, survival, and quality of life. Cardiol Young 2000; 10: 179185.
3.Majnemer A, Limperopoulos C, Shevell M, Rohlicek C, Rosenblatt B, Tchervenkov C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr 2008; 153: 5560.
4.Majnemer A, Limperopoulos C, Shevell M, Rosenblatt B, Rohlicek C, Tchervenkov C. Long-term neuromotor outcome at school entry of infants with congenital heart defects requiring open-heart surgery. J Pediatr 2006; 148: 7277.
5.Hovels-Gurich HH, Bauer SB, Schnitker R, et al. Long-term outcome of speech and language in children after corrective surgery for cyanotic or acyanotic cardiac defects in infancy. Eur J Paediatr Neurol 2008; 12: 378386.
6.Hovels-Gurich HH, Konrad K, Skorzenski D, Herpertz-Dahlmann B, Messmer BJ, Seghaye MC. Attentional dysfunction in children after corrective cardiac surgery in infancy. Ann Thorac Surg 2007; 83: 14251430.
7.Limperopoulos C, Majnemer A, Shevell MI, et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141: 5158.
8.Bellinger DC, Jonas RA, Rappaport LA, et al. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 1995; 332: 549555.
9.Karl TR, Hall S, Ford G, et al. Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: neurodevelopmental outcome. J Thorac Cardiovasc Surg 2004; 127: 213222.
10.Wernovsky G, Stiles KM, Gauvreau K, et al. Cognitive development after the Fontan operation. Circulation 2000; 102: 883889.
11.Miller G, Tesman JR, Ramer JC, Baylen BG, Myers JL. Outcome after open-heart surgery in infants and children. J Child Neurol 1996; 11: 4953.
12.Oates RK, Simpson JM, Cartmill TB, Turnbull JA. Intellectual function and age of repair in cyanotic congenital heart disease. Arch Dis Child 1995; 72: 298301.
13.Hovels-Gurich HH, Seghaye MC, Schnitker R, et al. Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation. J Thorac Cardiovasc Surg 2002; 124: 448458.
14.Limperopoulos C, Majnemer A, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurologic status of newborns with congenital heart defects before open heart surgery. Pediatrics 1999; 103: 402408.
15.McQuillen PS, Barkovich AJ, Hamrick SE, et al. Temporal and anatomic risk profile of brain injury with neonatal repair of congenital heart defects. Stroke 2007; 38: 736741.
16.Miller SP, McQuillen PS, Hamrick S, et al. Abnormal brain development in newborns with congenital heart disease. N Engl J Med 2007; 357: 19281938.
17.Limperopoulos C, Tworetzky W, McElhinney DB, et al. Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation 2010; 121: 2633.
18.Limperopoulos C, Majnemer A, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr 2000; 137: 638645.
19.Petit CJ, Rome JJ, Wernovsky G, et al. Preoperative brain injury in transposition of the great arteries is associated with oxygenation and time to surgery, not balloon atrial septostomy. Circulation 2009; 119: 709716.
20.Miller SP, Ferriero DM, Leonard C, et al. Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome. J Pediatr 2005; 147: 609616.
21.Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006; 355: 685694.
22.Mahle WT, Tavani F, Zimmerman RA, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation 2002; 106: I109I114.
23.Galli KK, Zimmerman RA, Jarvik GP, et al. Periventricular leukomalacia is common after neonatal cardiac surgery. J Thorac Cardiovasc Surg 2004; 127: 692704.
24.Kinney HC, Panigrahy A, Newburger JW, Jonas RA, Sleeper LA. Hypoxic-ischemic brain injury in infants with congenital heart disease dying after cardiac surgery. Acta Neuropathol 2005; 110: 563578.
25.McQuillen PS, Miller SP. Congenital heart disease and brain development. Ann N Y Acad Sci 2010; 1184: 6886.
26.Chau V, Poskitt KJ, McFadden DE, et al. Effect of chorioamnionitis on brain development and injury in premature newborns. Ann Neurol 2009; 66: 155164.
27.Glass HC, Bonifacio SL, Chau V, et al. Recurrent postnatal infections are associated with progressive white matter injury in premature infants. Pediatrics 2008; 122: 299305.
28.Wu YW, Colford JM Jr. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis. JAMA 2000; 284: 14171424.
29.Shah DK, Doyle LW, Anderson PJ, et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr 2008; 153: 170175.
30.Leviton A, Gilles F, Neff R, Yaney P. Multivariate analysis of risk of perinatal telencephalic leucoencephalopathy. Am J Epidemiol 1976; 104: 621626.
31.Leviton A, Gilles FH. An epidemiologic study of perinatal telencephalic leucoencephalopathy in an autopsy population. J Neurol Sci 1973; 18: 5366.
32.McQuillen PS, Hamrick SE, Perez MJ, et al. Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries. Circulation 2006; 113: 280285.
33.Block AJ, McQuillen PS, Chau V, et al. Clinically silent preoperative brain injuries do not worsen with surgery in neonates with congenital heart disease. J Thorac Cardiovasc Surg 2010; 140: 550557.
34.Petit JP, Rome JJ, Wernovsky G, et al. Preoperative brain injury in transposition of the great arteries is associated with oxygenation and time to surgery, not balloon atrial septostomy. Circulation 2009; 119: 709716.
35.Dent CL, Spaeth JP, Jones BV, et al. Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion. J Thorac Cardiovasc Surg 2006; 131: 190197.
36.Qamar ZA, Goldberg CS, Devaney EJ, Bove EL, Ohye RG. Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg 2007; 84: 871878.
37.Wernovsky G, Kuijpers M, Van Rossem MC, et al. Postoperative course in the cardiac intensive care unit following the first stage of Norwood reconstruction. Cardiol Young 2007; 17: 652665.
38.Back SA. Perinatal white matter injury: the changing spectrum of pathology and emerging insights into pathogenetic mechanisms. Ment Retard Dev Disabil Res Rev 2006; 12: 129140.
39.Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury of prematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93: F153F161.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 7 *
Loading metrics...

Abstract views

Total abstract views: 125 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th November 2017. This data will be updated every 24 hours.