Preoperative brain injury and neurodevelopmental outcomes in syndromic and non-syndromic children with complex congenital heart disease: a single-centre cohort study.

چکیده اصلی

UNLABELLED: Children with complex congenital heart disease (CHD) are at high risk of brain lesions both before and after cardiac surgery. Preoperative brain injury reflects foetal and perinatal brain development and represents an independent predictor of neurodevelopmental outcome. This study aimed to characterize preoperative brain lesions and their correlation with clinical course and neurodevelopmental outcomes in children with complex CHD. The secondary objective was to compare findings between syndromic and non-syndromic patients, as preoperative brain injury in syndromic children remains underreported. A single-centre cohort study was performed at the University of Padova, Italy, involving children with complex CHD who underwent preoperative brain MRI between January 2020 and October 2024. Patients were categorized based on the presence or absence of a known or suspected genetic syndrome. Neurological and neurodevelopmental evaluations were conducted pre- and postoperatively, and at 6- and 18-months follow-up. Among 54 enrolled patients, 21 (39%) had a suspected or confirmed genetic syndrome. Preoperative brain lesions were present in 24 children (44%), including 16/33 (48%) non-syndromic and 8/21 (38%) syndromic patients (OR 0.65 [0.21-1.94], p = 0.5708). Arterial ischemic stroke was the most common lesion (20%), followed by subdural haemorrhage (11%), cerebral sinovenous thrombosis (9%), and white matter injury (6%). Despite similar lesion rates, syndromic children showed more complicated perinatal histories and greater neurodevelopmental impairment, particularly in motor and language domains. CONCLUSION: Syndromic children with CHD do not have higher rates of preoperative brain injury but remain at greater neurodevelopmental risk. Further studies are warranted to confirm these findings. WHAT IS KNOWN: • Children with complex congenital heart disease (CHD) are at high risk for preoperative brain injury and neurodevelopmental impairment. • Syndromic children with CHD are often excluded from neurodevelopmental studies. WHAT IS NEW: • Preoperative brain lesions (44%), mainly arterial ischemic stroke (20%), are frequent in our cohort of syndromic and non-syndromic children with complex CHD. • Syndromic children with CHD do not show increased rates of preoperative brain injury compared to non-syndromic children, but remain a population at higher neurodevelopmental risk.

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