“Brain Development in Children with Congenital Heart Disease: From Fetus through Childhood”

Doctor's Name: 
Lisa Paquette, M.D.
Hospital/Institution: 
Children’s Hospital of Los Angeles, Los Angeles

The majority of children with congenital heart disease (CHD) are now surviving. While this is fantastic, this also gives us new challenges as it is becoming apparent that CHD children’s brains struggle to function normally. We aim to use advanced MRI approaches for CHD fetuses and neonates to help identify brain injury patterns that may indicate that abnormal brain function is likely. This study is unique as it is the only one in which the brain development will be followed by brain imaging and developmental testing from the fetal period throughout childhood in the same individual and has a sizable population of premature babies with CHD for comparison. It is our belief that the last trimester of gestation is a critical period for development of the brain, and the presence of CHD contributes to later brain injury and difficulties in brain functioning. As a portion of this comprehensive study, the next year would involve:

Specific Aims:

  1. On brain MRIs comparing specific chemical compositions related to metabolism and sizes of structures thought to be important to brain functions across the premature babies with CHD, term babies with CHD, and babies without CHD. These measurements will be correlated with the type of heart lesion, whether or not brain injury was seen on the newborn’s MRI, and the developmental testing results at 18 months of age.
  2. On brain MRIs comparing specific chemical compositions related to metabolism and sizes of structures  thought to be important to brain functions between CHD fetuses and fetuses without CHD. These measurements will be correlated with the type of heart lesion, whether or not brain injury was seen on the newborn’s MRI, and the developmental testing results at 18 months of age.

This study is inviting pregnant mothers whose fetus has CHD. Involvement in the study includes allowing access to the fetal MRI (done as routine standard of care), a limited pre-operative and post-operative brain MRI (if the newborn is stable enough), then developmental testing at 18 months.. Additionally, mothers who are interested in having a research fetal MRI, a brain MRI for their newborn, and developmental testing at 18 months are being sought. (Because the developmental testing is performed by our clinical staff, any issues that arise are able to be addressed and the child and family advocated for per routine.)

The information to be gained by this research will have a significant impact on the treatment of CHD because it may enable clinicians to detect and hopefully eventually prevent or lessen some brain abnormalities. And, it will allow health care providers to prepare families for how to handle those brain abnormalities that cannot be prevented. With this study we expect to accrue statistically significant numbers for each type of heart lesion over many years to be able to provide very specific information to families.

Additionally, because our team is composed of many bright minds from a variety of backgrounds (perinatology, pediatric cardiology, cardiothoracic surgery, pediatric radiology, imaging specialists, neonatology, neuropsychology, neurology), such a multidisciplinary approach to continual data analysis and patient care will provide us insight into many smaller questions as well—perhaps some we have not even considered yet—which will improve the daily care we provide for CHD patients.

Award Date 1: 
2013
Award Amount 1: 
$68,635
Award Date 2: 
2014
Award Amount 2: 
$68,000