Neonatal Brain Striatal Tissue Iron Deposition in Congenital Heart Disease: The Effect of Early Life and Surgery on Development

Abstract

Infants with congenital heart disease are now frequently surviving into adulthood but experience poor neurodevelopmental outcomes, including reduced cognitive and executive functioning. There is a critical need to link brain development to modifiable disease characteristics so we can offer intervention when the brain is most plastic. Brain dysmaturation in CHD is frequently experienced and likely impacted by the iron deficiency CHD infants experience from their disordered blood flow. Iron deficiency is significant for cognitive and executive function because striatal iron stores are needed for dopamine synthesis. Here we assess, with MRI, how striatal iron in CHD is different than in controls and how iron is impacted or related to various clinical characteristics. We find CHD participants had less iron than controls, indicating iron deficiency impacts deposition. Single ventricle infants had even less than other CHD participants post operatively. Within the CHD group, increased iron, through iron recycling, can also be indicative of cell death from hypoxia or ischemia. We find additional evidence for this relationship, where increased iron was related to poor APGAR scores pre-surgery. Iron supplantation is a promising intervention to optimize cognitive and executive function in CHD