{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T09:18:02Z","timestamp":1774516682059,"version":"3.50.1"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background and Purpose\u2014<\/jats:italic>\n            <\/jats:bold>\n            Newborns with congenital heart disease are at high risk for brain injury and adverse neurodevelopmental outcomes. MRI enables the objective determination of the severity of brain injury in critically ill newborns with congenital heart disease. We will rationalize the use of MRI as a surrogate for neurodevelopmental outcome and describe novel randomization techniques that can be used in trials in this population.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods\u2014<\/jats:italic>\n            <\/jats:bold>\n            This article describes the evidence for the use of MRI and the link with neurodevelopmental outcome established in newborns. We also discuss the use of adaptive randomization techniques for future clinical trials in newborns with congenital heart disease. These strategies will be highlighted using an example.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            Brain injuries occur with high frequency in newborns with congenital heart disease. It is not until school age that the full extent of neurological sequelae becomes apparent and the rapid pace of innovation in neonatal cardiac surgery prevents timely evaluation of changes in care. MRI provides a timely, safe, and reliable outcome measure and has been extensively studied in newborns with other conditions in which the link between brain injury and neurodevelopmental outcome has been established. Clinical trials using MRI as an outcome measure as well as adaptive randomization can improve the efficiency of such trials.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            Clinical trials of brain protection are urgently needed in newborns with congenital heart disease given the unacceptable frequency of brain injury in this population; MRI provides an early surrogate marker of long-term neurodevelopmental outcome and adaptive randomization can be used to improve the efficiency of these clinical trials.\n          <\/jats:p>","DOI":"10.1161\/strokeaha.108.522664","type":"journal-article","created":{"date-parts":[[2008,11,7]],"date-time":"2008-11-07T02:46:32Z","timestamp":1226025992000},"page":"327-332","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Preventing Brain Injury in Newborns With Congenital Heart Disease"],"prefix":"10.1161","volume":"40","author":[{"given":"Rebecca L.","family":"Sherlock","sequence":"first","affiliation":[{"name":"From the Departments of Pediatrics (R.L.S., S.P.M.) and Healthcare and Epidemiology (R.L.S.), University of British Columbia, Vancouver, British Columbia, Canada; The Centre for Applied Health Research and Evaluation (R.L.S.), Vancouver, British Columbia, Canada; and the Departments of Pediatrics and Neurology (P.S.M., S.P.M.), University of California, San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick S.","family":"McQuillen","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (R.L.S., S.P.M.) and Healthcare and Epidemiology (R.L.S.), University of British Columbia, Vancouver, British Columbia, Canada; The Centre for Applied Health Research and Evaluation (R.L.S.), Vancouver, British Columbia, Canada; and the Departments of Pediatrics and Neurology (P.S.M., S.P.M.), University of California, San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven P.","family":"Miller","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (R.L.S., S.P.M.) and Healthcare and Epidemiology (R.L.S.), University of British Columbia, Vancouver, British Columbia, Canada; The Centre for Applied Health Research and Evaluation (R.L.S.), Vancouver, British Columbia, Canada; and the Departments of Pediatrics and Neurology (P.S.M., S.P.M.), University of California, San Francisco, Calif."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2005.09.009"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.6.723"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.1.95"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2007.03.058"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20557"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-005-1077-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2003.09.053"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.566752"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.122307"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01886-7"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951100009082"},{"key":"e_1_3_2_12_2","unstructured":"The Public Health Agency of Canada. 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