Neurodevelopmental impairment in children with congenital diaphragmatic hernia: Not an uncommon complication for survivors

ObjectivePrevious outcome reports of congenital diaphragmatic hernia (CDH) have described neuroimaging anomalies and neurodevelopmental impairment. However, the link between imaging and outcome has not been described. We aimed to determine whether routine postoperative neonatal neuroimaging in infants with CDH detects later neurodevelopmental impairment.MethodsIn a prospective cohort study within a clinical service in The Royal Children’s Hospital Newborn Intensive Care. Cerebral ultrasound was performed in 81 children and MRI in 57 children who subsequently underwent neurodevelopmental follow-up after surgery for CDH. MRI scans were analyzed using a scoring system designed to identify injury, maturation and volume loss. Neurodevelopmental assessment occurred at 2 years (48) and neurocognitive assessment at 5 years (26) and/or 8 years (27). Brain imaging scores corrected for gestational age at scan time were correlated with outcome measures, adjusting for known clinical confounders.ResultsClinically significant findings were identified on MRI of 16 (28%) infants. Mean scores were in the normal range for all domains assessed at each age. Language impairment was seen in 23% at 2 years and verbal intellectual impairment in 25% at 8 years. Mean cognitive scores were lower in 2-year-old children with white matter injury on MRI (p=0.03). Mean motor scores were lower in 2-year-old children with brain immaturity (p=0.01). Associations between MRI and 5-year and 8-year assessments were no longer significant when adjusting for known clinical confounders.ConclusionsNeuroimaging abnormalities were associated with worse neurodevelopment at 2 years, but not with later neurocognitive outcomes, after accounting for clinical risk factors.

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P649 Uncommon complication after congenital diaphragmatic hernia repair in a newborn

10.1136/archdischild-2019-epa.980 ◽

2019 ◽

Author(s):

Manel Charfi ◽

Amel Ben Hamad ◽

Hayet Zitouni ◽

Chiraz Regaieg ◽

Amira Bouraoui ◽

...

Keyword(s):

Hernia Repair ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Diaphragmatic Hernia Repair ◽

Uncommon Complication

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Morphometric Analysis of Brain in Newborn with Congenital Diaphragmatic Hernia

Brain Sciences ◽

10.3390/brainsci11040455 ◽

2021 ◽

Vol 11 (4) ◽

pp. 455

Author(s):

Martina Lucignani ◽

Daniela Longo ◽

Elena Fontana ◽

Maria Camilla Rossi-Espagnet ◽

Giulia Lucignani ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Fetal Mri ◽

Left Frontal Lobe ◽

Total Lung Volume ◽

Temporal Lobes ◽

Neurodevelopmental Impairment ◽

Gyrification Index ◽

Magnetic Resonance Imaging Mri ◽

Oxygen Perfusion

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.

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