Morphometric Analysis of Brain in Newborn with Congenital Diaphragmatic Hernia

Abstract

Congenital diaphragmatic hernia (CDH) is a severe pediatric disorder with herniation of abdominal viscera into the thoracic cavity. Since neurodevelopmental impairment constitutes a common outcome, we performed morphometric magnetic resonance imaging (MRI) analysis on CDH infants to investigate cortical parameters such as cortical thickness (CT) and local gyrification index (LGI). By assessing CT and LGI distributions and their correlations with variables which might have an impact on oxygen delivery (total lung volume, TLV), we aimed to detect how altered perfusion affects cortical development in CDH. A group of CDH patients received both prenatal (i.e., fetal stage) and postnatal MRI. From postnatal high-resolution T2-weighted images, mean CT and LGI distributions of 16 CDH were computed and statistically compared to those of 13 controls. Moreover, TLV measures obtained from fetal MRI were further correlated to LGI. Compared to controls, CDH infants exhibited areas of hypogiria within bilateral fronto-temporo-parietal labels, while no differences were found for CT. LGI significantly correlated with TLV within bilateral temporal lobes and left frontal lobe, involving language- and auditory-related brain areas. Although the causes of neurodevelopmental impairment in CDH are still unclear, our results may suggest their link with altered cortical maturation and possible impaired oxygen perfusion.

Brain development is altered in rabbit fetuses with congenital diaphragmatic hernia

“…A systematic review on the neurodevelopmental outcomes in CDH demonstrated that 16% of children born with isolated CDH have neurodevelopmental delay, mainly affecting motor function (13%) 12 . Furthermore, postnatal MRI studies have reported abnormal brain morphology, including enlarged extra‐axial spaces, intraventricular hemorrhage, ventriculomegaly, white matter injury, cerebellar hemorrhage, lower total maturation score, and hypogyria 13–17 . Some of these changes (enlarged extra‐axial spaces, ventriculomegaly, smaller cerebellar dimensions and delayed gyration) have also been described on fetal imaging; however, these studies show conflicting results 3,6,18,19 .…”

“…12 Furthermore, postnatal MRI studies have reported abnormal brain morphology, including enlarged extra-axial spaces, intraventricular hemorrhage, ventriculomegaly, white matter injury, cerebellar hemorrhage, lower total maturation score, and hypogyria. [13][14][15][16][17] Some of these changes (enlarged extra-axial spaces, ventriculomegaly, smaller cerebellar dimensions and delayed gyration) have also been described on fetal imaging; however, these studies show conflicting results. 3,6,18,19 All these raise the question whether neurodevelopmental problems in CDH are a consequence of postnatal events (surgery, intensive neonatal management with possible hypoxic episodes and hemodynamic instability) or if brain development is already compromised prenatally by the disease itself.…”

Outcomes of congenital diaphragmatic hernia among preterm infants: inverse probability of treatment weighting analysis

“…Neurodevelopmental impairment is an important complication in preterm infants with CDH 15,16,17,18,19 . Although the detailed mechanism is unknown, there are reports of central nervous system (CNS) abnormalities in CDH 20,21,22 . Congenital diaphragmatic hernia is a risk factor for hypoxic acidosis, which is a risk factor for CNS abnormalities during the disease.…”

Brain cortical assessment by MRI in fetuses with left congenital diaphragmatic hernia

“…The main finding is that the cingulate fissure, insular fissure and insular depth are significantly different in CDH fetuses compared with controls. The observation that up to 60% of infants with CDH shows signs of brain abnormalities on MRI performed before discharge from the neonatal intensive care unit (NICU) highlights the need to expand the study of the neurological aspects and pathophysiology of CDH in the prenatal period ( 2,14,(24)(25)(26)(27) ). The timing and mechanisms of neuropathological signs in children with CDH remain poorly studied and understood.…”