Exploring the intersection of social disparity, brain growth, and brain injury in children with congenital heart disease: Modifying neurodevelopmental outcomes
Pearl Zaki is a current third-year resident in Paediatric Neurology at the University of Toronto. During her residency, she has been involved in a research project which seeks to explore the relationships between brain growth and injury, neurodevelopmental outcomes, and social disparity in children with congenital heart disease. Supervised by Dr. Vann Chau at The Hospital for Sick Children and Dr. Thiviya Selvanathan at the University of British Columbia, Pearl’s work sheds light on how socioeconomic factors may contribute to health inequities in children with congenital heart disease. Her project, supported by the Edwin S.H. Leong Centre for Healthy Children Studentship Award, aims to inform more equitable approaches to pediatric care. A summary of her research is outlined below.
Children with congenital heart disease (CHD) are a vulnerable population with an elevated risk of neurodevelopmental impairment, which can affect all domains of development and persist through to adulthood. The severity of outcomes for these children can be impacted by many factors including the interplay between cardiac and brain development, surgical intervention, as well as broader environmental factors.
In our study, we looked at a retrospective cohort of children with CHD who underwent neonatal cardiac surgery with pre- and post-operative brain magnetic resonance imaging (MRI). We utilized the Ontario Marginalization Index, an area-based index that evaluates various dimensions of marginalization. We focused on the material resources dimension, which provides information about the access to and attainment of basic needs, such as housing, food, education, and clothing. We organized the index data into 3 groups: Group 1 representing the least marginalized and Group 3, the most marginalized. From the pre- and post-operative MRI, we assessed brain injury, including white matter injury, stroke, and intraventricular hemorrhage, and brain growth, using total brain volumes. Neurodevelopmental outcomes were measured using the Bayley-3 scales at 18 and 36 months.
In our initial analysis, we found that for the most deprived group of children, there were poorer cognitive outcomes at 18 months in those with brain injury and that greater brain volumes no longer predicted better cognitive and motor outcomes at 36 months. These results indicate to us that children who are marginalized are more likely to suffer severe neurodevelopmental impairments, regardless of the extent of brain injury or growth.
We are currently working on synthesizing our analyses to publish our findings. From what we have seen so far, social disparity does play a role in the complex relationships between disease, physiology, and neurodevelopment. Our hope is that our work will help inform strategies for equitable neurodevelopment among an already at-risk population.
I’d like to express my gratitude to the Edwin S.H. Leong Centre for Healthy Children for recognizing and supporting this project and encouraging my personal growth in research.
