Preoperative research brain imaging was conducted when the cardiothoracic intensive care unit (CTICU)/cardiology team determined the patient was stable for transport to the MRI scanner. Neonatal Brain Magnetic Resonance Imaging (MRI) and MRS Protocol Unplanned interventions first hospitalization (patients) Punctate white matter injury postoperatively Preoperative renal dysfunction, sepsis, or NEC We used quantitative short-echo 3T MRS, which allows for measurement of metabolites beyond that of long echo MRS technique (limited to n-acetyl aspartate, creatine, choline, and lactate) to include additional metabolites related to brain maturation (myo-inositol), neurotransmitters (glutamate and gamma-aminobutyric acid ), energy metabolism (glutamine, citrate, glucose, creatine, and phosphocreatine), and injury/ repair/apoptosis (lipids and lactate). We also compared intraoperative and postoperative factors with postoperative brain metabolite measurements. We compared multiple patient and preoperative factors with concurrent (pre- and postoperative) brain metabolite measurements. Here, we used quantitative MRS in term newborns with CHD to test the hypothesis that specific epochs of patient and clinical factors (ie, preoperative, intraoperative, and postoperative) are associated with metabolic brain dysmaturation and elevated lactate. 5– 13 MRS measures metabolites that are not only relevant to understanding structural brain maturation but also important for delineating physiological processes such as energy metabolism. 3, 4 Abnormalities of cerebral maturation have been de-lineated in CHD by the use of a variety of structural and metabolic neuroimaging techniques such as brain magnetic resonance spectroscopy (MRS). In addition, identifying modifiable risk factors that could help enhance long-term neurodevelopmental outcomes via future interventional clinical trials is a priority. 1, 2 The relationship between cerebral immaturity and risk factors of adverse neurodevelopmental outcome in patients with CHD is poorly defined. Neonates with complex congenital heart disease (CHD) are at risk for poor neurodevelopmental outcomes, which likely are related to an interplay of cerebral dysmaturation and acquired brain injury.
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