Congenital Heart Imaging Programme (CHiP)
Research type
Research Study
Full title
Neurodevelopment from the fetus to childhood in individuals with congenital heart disease assessed using MRI
IRAS ID
291178
Contact name
Serena Counsell
Contact email
Duration of Study in the UK
5 years, 0 months, 1 days
Research summary
Congenital heart disease (CHD) describes heart problems that develop before birth, affecting almost 1 in 100 babies in the UK. Survival of infants with CHD has improved greatly over the past 50 years, due to advances in diagnostics and heart surgery. Despite this, children with CHD do worse at school, with up to half of children experiencing problems with movement, cognition, memory, hyperactivity, attention, speech and language skills. This presents a large and growing public health problem, whilst the underlying cause remains largely unknown.
The placenta is an organ that develops in the womb during pregnancy. It is the interface between mother and fetus and provides the fetus with oxygen and nutrients. We will compare the function of the placenta in CHD cases to healthy controls. We will also use ground-breaking MRI scans to examine their brains in unprecedented detail and will compare brain development in babies with CHD to healthy babies in the womb and after birth. We will undertake assessments in these children at 22 months so we can link our findings of placental function, brain development and outcome. We expect to find differences in placental function that help explain why some babies with CHD are more vulnerable to brain damage.
We will also investigate how parental stress and parenting styles are related to the children’s outcome at 22 months as it may be possible to modify these factors to help to improve the children’s outcome.
This study will improve our understanding of why brain development is altered in some children with CHD, explain why these children experience difficulties at school, and will enable us to identify those children who could benefit from interventions to improve outcome.
Summary of Results:
Congenital heart disease (CHD) affects almost 1% of UK births and is the most frequent congenital malformation. Improvements in antenatal diagnosis, cardiac surgery, and perioperative care mean that most infants born with CHD now survive. However, children and adults with CHD who required cardiopulmonary bypass surgery in infancy are at increased risk of problems in childhood and beyond including problems in motor functions, mild impairments in executive function, attention and memory, difficulties with social interactions and emotional and behavioural problems. These may impact upon school achievement, employability and quality of life.
This study assessed the relationship between placenta and brain development in CHD. We also undertook neuroimaging soon after birth and assessments of cognitive and behavioural performance in children with CHD and controls at 2 years of age. We aimed to understand the causes of brain problems seen in some children with CHD and to provide imaging tools to test future therapies.
We found differences in lower oxygenation of the placenta in pregnancies affected by CHD compared to controls. We also observed smaller brain volumes in fetuses and newborns with CHD. However, the differences in brain volumes in children who had undergone corrective surgery when they were babies appeared to have diminished by the time the children were 6-8 years old. As a group, the children with CHD performed less well in cognitive tests at school age and in toddlerhood.
When we looked at the relationship between brain MRI measures and outcome, we found that brain MRI measures of volume and connectivity (an assessment of how different regions of the brain are wired together) soon after the babies were born were associated with cognition and behavioural measures in toddlerhood in children with CHD. Brain growth from soon after birth to middle childhood was associated with cognition (IQ) in middle childhood in children with CHD and controls.
In summary, we found alterations in the placenta and in brain development in fetuses and babies with CHD when compared to “heart healthy” groups. Some of these differences were related to how well the children performed in tests of cognition and behaviour when the participants were toddlers. Brain growth in the first few years of life was associated with how well children performed in IQ tests at 6-8 years.REC name
Wales REC 4
REC reference
21/WA/0075
Date of REC Opinion
8 Mar 2021
REC opinion
Favourable Opinion