اكتشاف طبيب الاجنه ل تشوهات القلب عند الجنين قبل الولاده يودي الى تقليل امراض الدماغ من اكتشافها بعد الولاده
والسبب هو انه مباشره يعالج الجنين بماده ال prostaglandin والتي سوف تتاخر لو تم الاكتشاف بعد الولاده
Prenatal Diagnosis of Critical Congenital Heart Disease Tied to Less Brain
By Will Boggs MD
February 26, 2016
NEW YORK (Reuters Health) – Neonates with a prenatal diagnosis of critical congenital heart disease (CHD) are less likely than those with a postnatal diagnosis to experience brain injury, researchers report.
Prenatal detection of critical CHD improves the perioperative cardiovascular condition of these neonates, but little is known about the relationship with brain injury.
Dr. Shabnam Peyvandi from the University of California, San Francisco, and colleagues compared the prevalence of preoperative and postoperative brain injury and the trajectory of brain development in 153 neonates with transposition of the great arteries (TGA) and single ventricle physiology (SVP); 67 infants had a prenatal diagnosis of CHD and 86 did not.
The prevalence of preoperative brain injury was 24% in neonates with prenatal diagnosis and twice as high (48%) in neonates with postnatal diagnosis (p=0.003), the team reports in JAMA Pediatrics, online February 22.
The prevalence of postoperative brain injury was similar in the prenatal and postnatal diagnosis groups.
Postnatal microstructural brain development was faster in neonates with prenatal diagnosis than in those with postnatal diagnosis, ranging from 50% (gray matter) to 70% (white matter) faster in the very short period between preoperative and postoperative MRIs.
“The mechanism behind these findings is likely related to a better hemodynamic state as a result of earlier use of prostaglandin E1,” the researchers speculate. “However, it remains to be determined how this potential protective effect relates to long-term outcomes as it is unlikely to influence other patient-specific risk factors such as genetic predispositions, intraoperative injuries, or postoperative hemodynamics.”
“Further studies are needed to determine whether decreased preoperative brain injury and improved brain growth related to prenatal diagnosis translate into better long-term neurodevelopmental outcomes,” they add.
Dr. Matt Oster, director of Children’s CORPS (Cardiac Outcomes Research Program at Sibley Heart Center), Emory University, Atlanta, Georgia, said, “Improved prenatal detection rates may help decrease the birth prevalence of brain injury in children with severe congenital heart defects, but still about one-quarter of these children will have some evidence of brain injury in even the best of circumstances.”
“While we have known for some time that earlier diagnosis allows the child with congenital heart disease to be more clinically stable prior to going to the operating room, this benefit has not translated to better long-term survival, presumably because it is the infants with the most severely affected cases of congenital heart disease who are most easily detected prenatally and who are most at risk for mortality,” he told Reuters Health by email.
“Similarly, it remains to be seen whether infants diagnosed prenatally will have better long-term neurodevelopmental outcomes, but this study does provide some reason for hope,” said Dr. Oster, who was not involved in the research.
Dr. Peyvandi did not respond to a request for comments.
JAMA Pediatr 2016.