Research: Prenatal Brain Maturation is Delayed in Neonates with Congenital Diaphragmatic Hernia

J Pediatr

. 2023 Sep 16;113738.

 doi: 10.1016/j.jpeds.2023.113738. Online ahead of print.

Prenatal Brain Maturation is Delayed in Neonates with Congenital Diaphragmatic Hernia

Sandy Johng 1Daniel J Licht 2Holly L Hedrick 3Natalie Rintoul 4Rebecca L Linn 5Juliana S Gebb 6Rui Xiao 7Shavonne L Massey 2

Affiliations expand


Objective: To assess brain development in fetuses with congenital diaphragmatic hernia (CDH) using a fetal Total Maturation Score (fTMS).

Study design: This is a retrospective cohort study using data from a single-center, clinical registry. Neonates with an antenatal diagnosis of CDH between 2014 – 2020 and prenatal brain magnetic resonance imaging (n = 48) were included. We compared our study sample with historical healthy controls (n = 48). The relationship between fTMS and gestational age, as well as the association between fTMS and key prenatal variables and placental pathologic findings, were evaluated.

Results: Compared with healthy controls, neonates with CDH had a significant delay in fTMS (p-value <0.001). Within the CDH cohort, there was no significant difference in fTMS based on CDH severity, intrathoracic liver position, right versus left CDH, sex, presence of abnormal echocardiogram findings, treatment with extracorporeal membrane oxygenation, or in-hospital mortality. Placentas of neonates with CDH had a high proportion of fetal vascular malperfusion (56%) and chronic inflammation (67%), and relatively large placentas had a protective effect on prenatal brain maturation (p-value = 0.025).

Conclusions: Prenatal brain maturation in neonates with CDH is delayed. Placental pathology may influence fetal brain development. The etiology and clinical impact of prenatal brain immaturity in neonates with CDH warrant further investigation.

Keywords: Fetal; Neuroimaging; Placenta.

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