Characterization and Support of Neurodevelopmental Disorders Associated With Congenital Cardiac malfoRmations - Neonatal

Nantes University Hospital450 enrolled

Overview

Congenital heart defects (CHD), as the leading cause of birth defects, affect 12 million people globally and approximately 41,000 newborns each year in Europe. CHD presents a significant public health concern due to its association with high morbidity and mortality rates across the lifespan. Over 50% of infants born with critical CHD will develop neurodevelopmental disorders (NDD), requiring specialized care and impacting their quality of life. NDDs, involving early and persistent disruptions in cognitive, emotional, and behavioral development due to abnormal brain development, are highly variable. They may impact language, learning, motor skills, intellectual efficiency, social cognition, attention, memory, and executive functions, often accompanied by psychosocial difficulties. These hidden disabilities constitute the primary long-term sequelae of CHD, surpassing even cardiovascular complications in impact, and affect children who often undergo multiple cardiac surgeries during early childhood. NDDs are associated not only with complex CHDs but also with simpler CHDs that are repaired in early childhood and considered 'cured.' The origin of CHD-associated NDDs remains largely unknown. While few genetic or environmental causes have been identified, recent research suggests a possible common origin linking heart malformations and neurodevelopmental abnormalities. The CATAMARAN neonatal cohort project aims to detect developmental delays associated with CHD as early as six months of age and to identify both individual susceptibility factors and acquired vulnerabilities contributing to the development of NDDs in infants with CHD.

Study Type

OBSERVATIONAL

Enrollment

450

Conditions

Heart Disease Congenital Neurodevelopmental Disorder

Neurodevelopmental assessment (Bayley-IV)BEHAVIORAL

Assessment of developmental delays through administration of the Bayley-4 test by a neuropsychologist

Biological samplingOTHER

The samples to be collected at delivery will include: * A 4 ml maternal blood sample in an EDTA tube for lipidomic and metabolomic analyses at delivery * A 6 ml maternal blood sample in an EDTA tube (2 tubes of 3 ml) for genetic analysis * A 4 ml venous cord blood sample in an EDTA tube for transcriptomic and epigenetic analysis; and a 2 ml EDTA tube for metabolomic/lipidomic analysis * Samples from fresh placenta for transcriptomic, epigenetic, metabolomic, and lipidomic analyses * A meconium sample collected as soon as possible after birth in a dry tube for microbiome analysis During hospitalization for the cardiac surgery: * Genome analysis samples will be collected from the father and the infant. These samples will be taken in two EDTA tubes of 3 ml each. * Perioperative neurobiomarker samples will be collected (one EDTA tube of 500 μL preoperatively and postoperatively on Day 1 and 2). At 1 month, a stool sample will be collected from the infants for microbiome analysis.

ELFE dietary questionnaireBEHAVIORAL

Questionnaire on diet and lifestyle during pregnancy (only for the mother)

Post-Traumatic Stress Questionnaire IES-R (Impact of Event Scale - Revised)BEHAVIORAL

The IES-R is a 22-item self-report measure (for DSM-IV) that assesses subjective distress caused by traumatic events.

Data collection for the study (Cardiovascular, developemental, fetal, pregnancy, MRI)OTHER

* Cardiovascular follow-up data collection * Developmental follow-up data collection * Collection of postoperative brain MRI data, scheduled between Day 5 post-surgery and the end of the hospital stay * Collection of data on pregnancy exposure, obstetric events, and delivery data. * Collection of fetal ultrasound data (T2 and T3). * Collection of fetal echocardiography data (T2 and T3).

Eligibility

Sex: ALL

Medical Language ↔ Plain English

The inclusion criteria are as follows: * Fetus with a congenital heart defect (CHD) detected prenatally (prenatal diagnosis of the heart defect) * Fetus with a critical CHD defined as requiring cardiac surgery during the first three months of the infant's life * Parents affiliated with or beneficiaries of a social security or equivalent system * Parents' good understanding of the French language * Voluntary, informed, and written consent from both parents for themselves and the unborn child Criteria for parents\*: \- Biological parents \*The inclusion of the father in the project does not limit the participation of the child (patient) in the study. \*The father will be encouraged to participate in the project by providing a blood sample to create a trio (mother/father/infant) for future genetic analyses. However, if the father is unavailable or does not consent to the collection and storage of samples for analysis (as part of the CATAMARAN study or future research projects related to biobanking), the child can still be included in the study. Exclusion Criteria: * Medical termination of pregnancy considered * Genetic anomaly or malformative syndrome identified prior to inclusion

Outcomes

Primary Outcomes

Evaluate the prevalence of developmental delays in infants with a critical congenital heart defect (CHD) at 6 months of age.

Time frame: 6 months

Secondary Outcomes

Evaluate the prevalence of developmental delay in infants with congenital heart defects (CHD) based on the type of heart defect.

Time frame: 6 months

Assess the presence of developmental delay in infants with CHD based on the complexity of cardiac surgery.

Time frame: 6 months

Evaluate and describe affected developmental domains.

Time frame: 6 months

Identify rare genetic variants associated with developmental delays in CHD patients through genome-wide analysis.

Time frame: 6 months

Identify common genetic variants associated with developmental delays in CHD patients through genome-wide analysis.

Time frame: 6 months

Characterize placental anatomopathological anomalies in CHD and their correlation with developmental delay at 6 months.

Time frame: 6 months

Determine maternal dietary habits during the third trimester, their correlation with placental anomalies, and developmental delay at 6 months.

Time frame: 6 months

Characterize maternal behavioral exposures (e.g., tobacco, alcohol, drugs) and obstetric complications (e.g., hypertension, preeclampsia, gestational diabetes) during pregnancy, and their correlation with placental anomalies and developmental delay

Time frame: 6 months

Characterize antenatal determinants of developmental delay through multi-omics analysis (metabolomics, lipidomics, transcriptomics, and epigenetics) of maternal blood, placental function, and fetal blood, and their correlation with developmental delay

Time frame: 6 months

Characterize neonatal microbiota and its association with developmental delay at 6 months.

Time frame: 6 months

Identify perioperative determinants of developmental delay in CHD.

Time frame: 6 months

Identify optimal perfusion pressure targets during and after neonatal cardiac surgery under cardiopulmonary bypass in three participating centers using continuous analysis of invasive blood pressure and cerebral oxygen saturation

Time frame: up to 3 months

For CHU Nantes patients only: identify fetal neuronal biomarkers at birth, track their evolution before and after cardiac surgery in CHD infants, and establish associations with developmental delay at 6 months.

Time frame: 6 months

Evaluate parental post-traumatic stress at 1) antenatal inclusion, 2) perioperative period, and 3) 6 months post-surgery, and its correlation with developmental delay at 6 months.

Time frame: 6 months

Characterization and Support of Neurodevelopmental Disorders Associated With Congenital Cardiac malfoRmations - Neonatal

Overview

Conditions

Interventions

Eligibility

Locations (3)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts