Antenatal diagnosis, neonatal brain volumes, and neurodevelopment in transposition of the great arteries

AimTo examine whether antenatal diagnosis modifies relationships between neonatal brain volumes and 18-month neurodevelopmental outcomes in children with transposition of the great arteries (TGA).MethodIn a retrospective cohort of 139 children with TGA (77 antenatally diagnosed), we obtained total brain volumes (TBVs) on pre- (n = 102) and postoperative (n = 112) magnetic resonance imaging. Eighteen-month neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Generalized estimating equations with interaction terms were used to determine whether antenatal diagnosis modified associations between TBVs and neurodevelopmental outcomes accounting for postmenstrual age at scan, brain injury, and ventricular septal defect.ResultsInfants with postnatal diagnosis had more preoperative hypotension (35% vs 14%, p = 0.004). The interactions between antenatal diagnosis and TBVs were significantly related to cognitive (p = 0.003) outcomes. Specifically, smaller TBVs were associated with lower cognitive scores in infants diagnosed postnatally; this association was attenuated in those diagnosed antenatally.InterpretationAntenatal diagnosis modifies associations between neonatal brain volume and 18-month cognitive outcome in infants with TGA. These findings suggest that antenatal diagnosis may be neuroprotective, possibly through improved preoperative clinical status. These data highlight the need to improve antenatal diagnosis rates. We examined whether antenatal diagnosis modifies relationships between neonatal brain volumes and neurodevelopment in a clinical cohort of children with transposition of the great arteries. In infants with postnatal diagnosis, smaller neonatal brain volumes were associated with lower cognitive scores; these associations were not present in the antenatal diagnosis group. These findings suggest that antenatal diagnosis may be neuroprotective, possibly mediated through improved hemodynamic state in the preoperative period.image