The TRANSIT CHD study (The Risk of Acquired Neonatal Significant brain Injury during perinatal Transition in Congenital Heart Disease) is spanned in two sites, UCSF and The Hospital for Sick Children in Toronto, to perform longitudinal brain imaging beginning in utero and after birth, as well as use other neuromonitoring tools and echocardiography to understand the relationship between cardiac and cerebral physiology in neonates with d- Transposition of the great arteries (d-TGA).
Outcomes for children with d-TGA have significantly improved with restoration of normal cardiovascular physiology after the newborn operation. Despite this, children with d-TGA experience neurodevelopmental challenges across the lifespan suggesting that prenatal and neonatal physiology may have a lasting impact on ND outcome. Newborns with d-TGA are known to have delayed brain development beginning in utero and are at increased risk for acquired neonatal white matter injury with the majority observed before the neonatal operation. These observations and our preliminary data suggest that circulatory adjustments during perinatal transition from fetal to neonatal life may play a significant role in the susceptibility to injury after birth. Perinatal transition is a key time period with potential for neuroprotective interventions such as delayed cord clamping, which has been demonstrated to provide neuroprotection to term and preterm newborns. In this study, we aim to fill a significant gap in our field related to how physiologic changes in cardiovascular and cerebral hemodynamics during perinatal transition affect brain health in patients with d-TGA. Our long term goals are to use data from this proposal to design neuroprotective trials focused on the transitional time period that have the potential to optimize ND outcomes in this patient population.
