Recent advances in the management of congenital heart disease (CHD) have markedly reduced mortality. However, brain injury remains a major impediment to high quality of life in survivors. A growing body of literature suggests that a substantial component of this neurologic morbidity may be prenatal in origin. Our studies in CHD fetuses showed for the first time that impaired brain development occurs predominantly in the third trimester and is associated with evidence of impaired brain perfusion and anaerobic metabolism.
Quantifying Brain Development with MRI
The mechanism by which CHD disrupts fetal brain development remains unclear. We have developed and validated methods to safely and reliably quantify brain development and metabolism in the living fetus, and newborn using advanced magnetic resonance imaging (MRI) techniques. In the current proposal, we plan to apply echocardiographic measures of the fetal circulation (as well as quantitative MRI methods) to identify the earliest biomarkers for impaired brain development in the fetus with CHD.
We will accomplish this by addressing the following specific aims: 1) to determine whether abnormalities in cortical development and brain metabolism (by quantitative MRI and Magnetic Resonance Spectroscopy) are an early marker for risk of impaired volumetric brain growth in the fetus with CHD compared to control fetuses , 2) to determine whether systemic and cerebral hemodynamic perfusion abnormalities (by echocardiography/Doppler US) predict impaired brain growth and/or elevated cerebral lactate in the fetus with CHD versus controls, and 3) to examine the early and long-term neurodevelopmental significance of fetal biomarkers for impaired brain development identified in aims 1 and 2.
Our goal is to develop the capacity to reliably and non-invasively identify fetuses with CHD at risk for early brain injury. This, in turn, will begin to open windows for the development of therapeutic interventions aimed at preventing or limiting impaired brain development in these high-risk fetuses.
The ABC Study – or Antenatal Brain Cardiac study – Seeks to better understand brain development in babies with congenital heart defects.
Although infants with a heart problem are at greater risk for problems with brain development, the precise effect, if any, of the heart problem on the development of the brain remains poorly understood.
We study the brain as it is developing during pregnancy, through a technique called fetal MRI. Enrolled babies have also an MRI scan shortly after birth to look at the brain in the newborn period.
Cognitive & Social-Behavioral Development
We also aim to evaluate the relationship between brain development and cognitive and social-behavioral development in this population.
“Our research focuses on the developing brain, both in utero and in the newborn stages of life.”
We are developing advanced MRI (magnetic resonance imaging) techniques to examine the structure, connectivity, and metabolism of the brain in ways that cannot be done with conventional MRI studies. It is our long-term goal to be able to identify babies with impaired brain growth as soon as possible, so that the proper interventions and clinical planning can take place.