Prenatal cerebellar growth is altered in congenital diaphragmatic hernia on ultrasound

Abstract

Objective: Children with congenital diaphragmatic hernia (CDH) are at risk for neurodevelopmental delay. Herein we report on prenatal changes in biometry and brain perfusion in fetuses with isolated CDH.Study Design: This retrospective study evaluated fetuses with isolated, left-sided CDH in three European referral centers. Abdominal circumference (AC), femur length (FL), head circumference (HC), transcerebellar diameter (TCD), middle cerebral artery (MCA) Doppler, and ventricular width (VW) were assessed during four gestational periods (<24 weeks, 25-28 weeks, 29-32 weeks, >33 weeks). Z-scores were calculated, and growth curves were created based on longitudinal data. Results:In 367 fetuses, HC, AC and FL were within normal ranges throughout gestation. The TCD diminished with advancing gestational age to fall below the fifth percentile after 32 weeks. A less pronounced but similar trend was seen in VW. The peak systolic velocity of the MCA was consistently approximately 10% lower than normal. Disease severity was correlated to TCD (p = 0.002) and MCA doppler values (p = 0.002). There were no differences between fetuses treated with FETO and those managed expectantly.

Longitudinal MRI Evaluation of Brain Development in Fetuses with Congenital Diaphragmatic Hernia around the Time of Fetal Endotracheal Occlusion

“…In earlier studies, scores using the same system correlated well with the Neonatal Behavioral Assessment Scale, 31 though this correlation was in fetuses with isolated nonsevere ventriculomegaly or late-onset growth restriction. 14,22 The functional impact of our observations in fetuses with CDH remains to be elucidated. Moreover, one must take into account that any abnormality observed postnatally may as well have been acquired after birth.…”

“…We have previously reported a decline in the systolic velocity of the MCA peak, hence in brain perfusion in fetuses with CDH. 14,32 One may recognize similarities to circulatory disturbances in fetuses with congenital heart defects, which coincide with signs of abnormal brain development. In hypoplastic left heart syndrome, a lower blood flow velocity has been associated with lower brain volume.…”

“…We also correlated these to disease severity. 14 The objective in the present study was to use MR imaging data to document cortical folding as well as the dimensions and volume of given brain structures in comparison with findings in healthy fetuses, again, in particular, late in gestation.…”

Antenatal management of congenital diaphragmatic hernia: What's next ?

“…Neurodevelopmental delay, hearing, learning and behavioral problems have been reported in up to 16% of children with isolated CDH 74 and postnatal MRI studies demonstrated abnormalities such as delayed sulcation and white matter injury 75‐77 . This may be due to postnatal events but could also originate in utero, as has been observed in fetuses with cardiopathies, 78,79 and recently suggested for cerebellar development in CDH fetuses 80 …”

“…[75][76][77] This may be due to postnatal events but could also originate in utero, as has been observed in fetuses with cardiopathies, 78,79 and recently suggested for cerebellar development in CDH fetuses. 80…”