Serial neurosonography in fetuses with congenital heart defects shows mild delays in cortical development

Introduction: Neurodevelopmental delay is more common in children born with congenital heart defects (CHD), even with optimal perinatal and peri-operative care. It is hypothesized that fetuses with CHD are prone to neurological impairment in utero due to their cardiac defect, possibly leading to delayed cortical development. Methods: Cerebral cortical maturation was assessed with advanced neurosonographic examinations every 4 weeks in fetuses with CHD and compared to control fetuses. Five different primary fissures and four areas were scored (ranging 0–5) by blinded examiners using a cortical maturation scheme. Results: Cortical staging was assessed in 574 ultrasound examinations in 85 CHD fetuses and 61 controls. Small differences in grading were seen in Sylvian and cingulate fissures. (Sylvian fissure: −0.12 grade, 95% CI (−0.23; −0.01) p = 0.05, cingulate fissure: −0.24 grade, 95% CI (−0.38; −0.10) p = <0.001. Other cortical areas showed normal maturation as compared to control fetuses. Conclusion: Small differences were seen in three of the nine analyzed cortical areas in CHD fetuses, in contrast to previous reports on progressive third-trimester delay. The clinical implications of the small differences however, remain unknown.