Association of Prenatal Diagnosis of Critical Congenital Heart Disease With Postnatal Brain Development and the Risk of Brain Injury

Abstract

Prenatal detection of congenital heart disease (CHD) has incrementally increased during the last 2 decades with improvements in ultrasonographic technology and increased rigor of screening ultrasonography in the obstetrical community.^1-4 In particular, earlier detection of critical CHD requiring intervention in the newborn period has allowed for planned deliveries at or near a tertiary hospital with a congenital cardiac surgery program and intensive care units equipped to manage these neonates.^5,6 Prenatal detection of critical CHD has been shown to improve the perioperative clinical condition of these neonates, with preserved preoperative hemodynamics and fewer life-threatening events for ductal-dependent lesions such as transposition of the great arteries (TGA) and hypoplastic left heart syndrome.^7-11 Despite these apparent benefits, initial studies of prenatal diagnosis have not shown improved surgical outcomes and have even been associated with worse survival.¹² Although the survival disadvantage may be attributable to increased detection rates of more severe defects, studies have demonstrated a potential disadvantage to prenatal diagnosis in the form of earlier gestational age at delivery and lower birth weight, both of which appear to affect morbidity and mortality.¹³ Given conflicting effects of prenatal diagnosis, further consideration of the effect of prenatal diagnosis on postnatal physiology, including brain health, may help to maximize potential benefits.