Neurodevelopment from the fetus to childhood in individuals with congenital heart disease

Importance

Congenital heart disease (CHD) describes heart problems that develop before birth, affecting almost 1 in 100 babies in the UK. Survival of infants with CHD has improved greatly over the past 50-years, due to advances in diagnostics and heart surgery. Despite this, children with CHD do worse at school, with up to half of children experiencing problems with movement, cognition, memory, hyperactivity, attention, speech and language skills.

This presents a large and growing public health problem, whilst the underlying cause remains largely unknown. Our study

The placenta is an organ that develops in the womb during pregnancy. It is the interface between mother and fetus and provides the fetus with oxygen and nutrients. We will compare the function of the placenta in CHD cases to healthy controls.

We will also use ground-breaking MRI scans to examine their brains in unprecedented detail and will compare brain development in babies with CHD to healthy babies in the womb and after birth. We will undertake assessments in these children at 18 months so we can link our findings of placental function, brain development and outcome. We expect to find differences in placental function that help explain why some babies with CHD are more vulnerable to brain damage.

We will also study 7-year old children who have CHD and healthy control children. The children will have a brain MRI and we will test their ability to perform a number of different tasks, which will highlight any problems they may have with cognition, attention, behaviour and how well they can interact with their families and other people. We undertook brain MRI scans when these children were babies and we will see how their brain development just after they were born is related to how well they perform on these tasks.

We will also investigate how parental stress and parenting styles are related to the children's outcome at 18 months and 7-years as it may be possible to modify these factors to help to improve the children's outcome.

This study will improve our understanding of why brain development is altered in some children with CHD, explain why these children experience difficulties at school, and will enable us to identify those children who could benefit from interventions to improve outcome. Provision of effective interventions to protect brain health in these children at an early stage will help place vulnerable children onto healthy developmental trajectories, hence avoiding severe distress to children and their families and expense to society at large.