Preoperative serum cortisone levels are associated with cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: new evidence from human populations and mice

Abstract

Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Children with TOF would be confronted with neurological impairment across their lifetime. Our study aimed to identify the risk factors for cerebral morphology changes and cognition in postoperative preschool-aged children with TOF. Methods We used mass spectrometry (MS) technology to assess the levels of serum metabolites, Wechsler preschool and primary scale of intelligence-Fourth edition (WPPSI-IV) index scores to evaluate neurodevelopmental levels and multimodal magnetic resonance imaging (MRI) to detect cortical morphological changes. Results Multiple linear regression showed that preoperative levels of serum cortisone were positively correlated with the gyrification index of the left inferior parietal gyrus in children with TOF and negatively related to their lower visual spaces index and nonverbal index. Meanwhile, preoperative SpO2 was negatively correlated with levels of serum cortisone after adjusting for all covariates. Furthermore, after intervening levels of cortisone in chronic hypoxic model mice, total brain volumes were reduced at both postnatal (P) 11.5 and P30 days. Conclusions Our results suggest that preoperative serum cortisone levels could be used as a biomarker of neurodevelopmental impairment in children with TOF. Our study findings emphasized that preoperative levels of cortisone could influence cerebral development and cognition abilities in children with TOF.

Stress Markers, Executive Functioning, and Resilience Among Early Adolescents With Complex Congenital Heart Disease

“…An exploratory study in 15 children with tetralogy of Fallot found that the morphology of the inferior parietal gyrus was associated with preoperative cortisone levels and cognition. However, a direct link between cortisone/cortisol and cognition was not examined . Overall, little is known about the influence of stress on EFs in cCHD, but studies in healthy individuals indicate a link between low EF performance and high stress measured by cortisol levels .…”

“…However, a direct link between cortisone/cortisol and cognition was not examined. 14 Overall, little is known about the influence of stress on EFs in cCHD, but studies in healthy individuals indicate a link between low EF performance and high stress measured by cortisol levels. 15 , 16 , 17 The underlying mechanisms remain unclear.…”

Preoperative cardiac structural changes are associated with subcortical nuclei changes and neurocognition in preschool-aged children with tetralogy of Fallot after corrective surgery

“…Pediatric studies have shown that children with CCHD usually have abnormal brain changes detected by magnetic resonance imaging (MRI), manifested as reduced brain volume, delayed brain maturation, white matter damage and stroke [14][15][16][17][18][19]. In addition, abnormalities of delayed cortical development in CCHD are increasingly reported, mainly manifested as delayed cortical folding, asymmetric cortical depth, and reduced cortical thickness [20][21][22][23]. Meanwhile, they may have lower intelligence quotients (IQ) and more behavioral problems and de cits in executive function than their peers [24,25].…”