The Children’s Hospital of Philadelphia launched the Fetal Neuroprotection and Neuroplasticity Program which builds onto already growing evidence of the interaction of heart disease and brain development in the fetus. This program will systematically investigate innovative therapies to protect brain development and to prevent brain injury as early as possible before birth.
A joint project of the hospital’s Cardiac Center, the Fetal Heart Program, the Center for Fetal Diagnosis and Treatment, and the Division of Neurology, it is the first-ever comprehensive program dedicated to prenatal neuroprotection. While this program initially will focus on the fetus with congenital heart disease (CHD), it will expand in the future to include fetuses with other birth defects, such as congenital diaphragmatic hernia and pulmonary hypoplasia.
In the U.S., approximately one in every 120 newborns is diagnosed with CHD, making it the most common birth defect. Many newborns with CHD require either corrective or palliative open-heart surgery. As recently as the 1960s, only 20 percent of newborns with critical CHD survived to adulthood.
“Today, thanks to better diagnostic technologies and methods, including prenatal diagnosis, advances in surgery, and improved postoperative care, early survival is over 90 percent,” said J. William Gaynor, MD, cardiac surgeon and director of the Fetal Neuroprotection and Neuroplasticity Program. “However, with improved early outcomes has come the sobering recognition that there is an ongoing risk of late mortality as well as significant morbidity for these children. Indeed, neurodevelopmental disability is now recognized as the most common complication of critical CHD – those patients requiring cardiac surgery in infancy – and has the most negative impact on quality of life, academic performance, and opportunity for independence as an adult.”
Convincing evidence suggests that in order to prevent brain injury and improve outcomes, treatment to protect the brain must be initiated before birth. This research, much of it developed at CHOP, shows that in utero brain development is abnormal in fetuses with CHD, leading to delayed maturation, poor growth, and white matter injury.
“The lifetime continuum of care for congenital heart disease starts in utero,” said N. Scott Adzick, MD, surgeon-in-chief at CHOP. “We now have an opportunity to not only offer the best diagnostic care to the fetus with heart disease, but to also begin to explore ways in which we can optimize long-term outcomes from the neurocognitive perspective.”
The focus of the new program will be to investigate the factors that cause abnormal brain development in the fetus with a congenital heart defect and to conduct clinical trials of fetal interventions to determine whether novel prenatal treatments can reduce brain injury and improve neurodevelopmental outcomes in newborns with CHD who subsequently undergo cardiac surgery. The first such study will evaluate whether the hormone progesterone, administered prenatally to the mother, has a neuroprotective effect on brain development.
The Children’s Hospital of Philadelphia has long been a leader in pediatric cardiac care. More than 30 years ago, CHOP pioneered life-saving early surgeries for children with complex heart defects. Today, most forms of heart disease can be detected prior to birth.
“The Fetal Neuroprotection and Neuroplasticity Program is another innovative initiative in a long series of identifying opportunities to ensure that children with CHD not only survive, but truly thrive, as they grow into adulthood,” Dr. Gaynor said. “This program allows us to enhance our continuum of care from conception through adulthood.”
For more information, please visit The Children’s Hospital of Philadelphia’s Fetal Neuroprotection and Neuroplasticity Program.