Research: Prenatal cerebellar growth is altered in congenital diaphragmatic hernia on ultrasound

Prenat Diagn

. 2021 Jul 3. doi: 10.1002/pd.5993. Online ahead of print.

Lennart Van der Veeken 1 2Francesca M Russo 1 2Ewelina Litwinska 3Olga Gomez 4 5 6Doaa Emam 1 7Liesbeth Lewi 1 2David Basurto 1Stephen Van der Veeken 8Luc De Catte 1 2Eduard Gratacos 4 5 6Elisenda Eixarch 4 5 6Kypros Nicolaides 3Jan Deprest 1 2 9Affiliations expand


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.

Conclusion: Fetuses with isolated left-sided CDH have a small cerebellum and reduced MCA peak systolic velocity. Follow up studies are necessary to determine the impact of these changes on neurodevelopment.

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