No abstract

Objective: Literature suggests that prenatal diagnosis of critical congenital heart disease does not lead to improved mortality. However, it has been associated with better pre-operative conditions in single ventricle lesions and better neurodevelopmental outcome in transposition of the great arteries (TGA). We sought to describe the frequency of pre-operative brain injury in neonates with prenatal and postnatal diagnosis of TGA. We hypothesize that prenatally diagnosed neonates with TGA have a lower prevalence of pre-operative brain injury. Methods: Term newborns with TGA were studied with brain magnetic resonance imaging preoperatively to determine brain injury severity based on the presence of white matter injury and/or stroke. Comparisons were made between prenatal and postnatal diagnosis. Other variables compared included estimated gestational age at birth (EGA), birth weight (BW), lowest oxygen saturation, balloon atrial septostomy (BAS), age at surgery, and hospital mortality. Analysis was performed with Fisher’s exact test or Student t-test. Further analysis will be performed including data from other centers and cardiac diagnoses. Results: The presence of brain injury was significantly higher in postnatally diagnosed neonates than those prenatally diagnosed (Table). There were trends toward lower EGA, lower BW, higher oxygen saturation and younger age at surgery in the prenatal group. BAS did not differ by prenatal diagnosis. Mortality was low and the only two deaths were in the postnatal group. Conclusions: Prenatally diagnosed neonates with TGA have a lower prevalence of preoperative brain injury as compared to those diagnosed postnatally. This finding is significant even when other known risk factors for brain injury did not differ between groups. Our data is consistent with prior literature demonstrating lower EGA and BW in prenatally diagnosed patients. The impact of these findings on neurodevelopmental outcomes will be studied.