Revealing the Impact on Developing Brains
A recent breakthrough in medical research is shedding light on congenital heart disease (CHD) like never before. Researchers at Children’s National Hospital have harnessed the power of advanced imaging to uncover vital clues about how CHD alters the brain chemistry of unborn babies.
This discovery not only provides early insights into potential treatment strategies but also offers hope for infants who may face lifelong health challenges.
A Pioneering Study
Published in the Journal of the American College of Cardiology, this pioneering study delves into the intricate ways in which heart defects disrupt metabolic processes in the developing brain, with a particular focus on the critical third trimester of pregnancy when babies experience rapid growth.
“Over the past decade, our team has been at the forefront of developing safe and sophisticated ways to measure and monitor fetal brain health in the womb,”
said Dr. Catherine Limperopoulos, Director of the Center for Prenatal, Neonatal, and Maternal Health Research at Children’s National.
“By tapping into the power of advanced imaging, we were able to measure certain maturational components of the brain to find early biomarkers for newborns who are going to struggle immediately after birth.”
In one of the most extensive cohorts of congenital heart disease patients ever assembled, researchers studied the developing brains of 221 healthy unborn babies and 112 with CHD using magnetic resonance spectroscopy, a noninvasive diagnostic test capable of examining chemical changes in the brain. Their findings unveiled significant insights:
- Babies with CHD exhibited elevated levels of choline and lower levels of N-Acetyl aspartate-to-choline ratios compared to healthy counterparts, potentially indicating disrupted brain development.
- Infants with more complex CHD also showed higher levels of cerebral lactate, a worrying signal of oxygen deprivation, when compared to babies with two ventricle congenital heart disease.
- Elevated lactate levels were particularly pronounced in babies with two types of heart defects: transposition of the great arteries and single ventricle congenital heart disease, both requiring heart surgery soon after birth. Elevated lactate levels were also associated with a heightened risk of death, underscoring the need for timely interventions.
A Path Forward
This research offers a promising path forward. The imaging techniques employed in this study may serve as a roadmap for further investigation and may one day enable medical professionals to better plan for the care of these vulnerable infants immediately after birth.
“With important clues about how a fetus is growing and developing, we can provide better care to help these children not only survive but thrive in the newborn period and beyond,”
said Dr. Nickie Andescavage, a neonatologist at Children’s National and the paper’s first author.
A Widespread Issue
Congenital heart disease stands as the most common birth defect in the United States, impacting roughly 1% of all children born—equivalent to around 40,000 babies annually. While these defects can be life-threatening, those who survive face significantly higher risks of enduring lifelong neurological challenges, including cognitive deficits, social interaction difficulties, inattention, and impulsivity. These impacts often extend to other organ systems due to inefficient blood pumping from the heart.
An Urgent Quest for Biomarkers
Despite the known challenges, researchers are only beginning to identify biomarkers that can provide critical information about which babies may face the greatest struggles and require heightened care.
Supported by the National Institutes of Health and the District of Columbia Intellectual and Developmental Disabilities Research Center, the study at Children’s National Hospital aims to enhance this understanding.
“For many years, we have known that the brains of children with severe heart problems do not always develop normally, but new research shows that abnormal function occurs already in the fetus,”
said Dr. Kathleen N. Fenton, Chief of the Advanced Technologies and Surgery Branch at the National Heart, Lung, and Blood Institute.
“Understanding how the development and function of the brain are already different before a baby with a heart defect is born will help us to intervene with personalized treatment as early as possible, perhaps even prenatally, and improve outcomes.”