Prenatal Factors Associated with Postnatal Brain Injury in Infants with Congenital Diaphragmatic Hernia

Abstract

Fetal lung hypoplasia is associated with postnatal brain injury in congenital diaphragmatic hernia, suggesting that the severity of lung disease and associated treatments affect brain health as well. We found no evidence of prenatal brain parenchymal injury or maturational delay.

Morphometric Analysis of Brain in Newborn with Congenital Diaphragmatic Hernia

“…Firstly, the presence of these symmetrically distributed hypogyria areas suggests altered volumetric growth and maturation as it has been already seen in other postnatal CDH neuroimaging studies [ 12 , 13 , 15 , 32 ]. In particular, such altered maturation was actually assumed as the results of reduced myelination, cortical infolding [ 12 ] and delayed sulcation [ 14 ] occurring in CDH infants. Neuroimaging investigations had already shown evidence of brain injury, including parenchymal abnormalities and enlarged extra-axial spaces as the most common findings, usually attributed to delayed brain maturation [ 38 ], but no evidence of subtle alterations of cortical parameters has been reported so far.…”

“…Tracy et al reported abnormal prenatal neuroimaging findings in only 4 CDH patients, one of which had an abnormal cortical gyration pattern [ 15 ]. Recently, both traditional [ 14 ] and morphological [ 16 ] MRI investigation were performed on CDH fetuses, revealing associations between prenatal and postnatal enlarged extra-axial spaces, but an absence of delayed sulcation and parenchymal abnormalities in fetuses. Since brain parenchymal injury was absent in fetuses and appeared in the postnatal stage, they hypothesized that cortical alteration might be related to postnatal factors such as NICU stay, ECMO or surgery [ 16 ].…”

“…Early brain development alteration might occur long before neurological symptoms and consequently they could represent a first marker for future neurodevelopmental impairments [ 43 ]. In patients with CDH, MRI findings of postnatal brain injury were associated with motor dysfunction [ 15 ], lower cognitive scores and language deficits [ 9 , 10 , 12 ], but no correlation resulted between neurological outcome and prenatal MRI findings [ 14 ]. These findings were further confirmed for long-term outcomes, resulting in impaired language and visual motor skills, behavioral, cognitive, developmental delay and hearing loss.…”

“…Since the severity and outcome of CDH patients depends from lung volume, liver herniation and lung-to-head ratio [ 46 , 47 , 48 , 49 ], we might hypothesize a similar prognostic role for altered cortical morphometry. Based on recent findings revealing significant association of lung hypoplasia severity with postnatal brain injury in CDH [ 14 ], we postulated that reduced lung volumes could be associated with altered brain oxygenation, that in turn might lead to a delayed cortical development. Consequently, investigating vertex-wise correlation between LGI and TLV, we observed significantly correlated areas located within left frontal lobe (pars opercularis, pars traingularis) and bilateral temporal lobes (superior temporal).…”

“…Although neurological sequelae have been frequently described, the timing and mechanism of brain injury remain poorly understood [ 12 ]. Magnetic resonance imaging (MRI) allows us to investigate structural neuropathological lesions in CDH infants, revealing brain and parenchymal injuries [ 13 , 14 ], with ventricular enlargement and intracranial hemorrhage appearing already at the fetal stage [ 14 , 15 , 16 ]. Among MRI analysis, morphometric techniques could represent powerful tools as they allow investigating specific cortical parameters usually implicated in several neurodevelopmental disorders, thus moving a further step toward a better understanding of brain injury mechanisms.…”