Predicting neurodevelopmental outcomes in fetuses with isolated mild ventriculomegaly

BackgroundFetal ventriculomegaly is the the most common intracranial abnormality detected antenatally. When ventriculomegaly is mild and the only, isolated, abnormality detected (isolated mild ventriculomegaly (IMVM)) the prognosis is generally considered to be good. We aim to determine if there are features on in utero MRI (iuMRI) that can identify fetuses with IMVM who have lower risks of abnormal neurodevelopment outcome.MethodsWe studied cases recruited into the MRI to enhance the diagnosis of fetal developmental brain abnormalities in utero (MERIDIAN) study, specifically those with: confirmed IMVM, 3D volume imaging of the fetal brain and neurodevelopmental outcomes at 3 years. We explored the influence of sex of the fetus, laterality of the ventriculomegaly and intracranial compartmental volumes in relation to neurodevelopmental outcome.FindingsForty-two fetuses met the criteria (33 male and 9 female). There was no obvious correlation between fetal sex and the risk of poor neurodevelopmental outcome. Unilateral IMVM was present in 23 fetuses and bilateral IMVM in 19 fetuses. All fetuses with unilateral IMVM had normal neurodevelopmental outcomes, while only 12/19 with bilateral IMVM had normal neurodevelopmental outcomes. There was no obvious correlation between measure of intracranial volumes and risk of abnormal developmental outcomes.InterpretationThe most important finding is the very high chance of a good neurodevelopmental outcome observed in fetuses with unilateral IMVM, which is a potentially important finding for antenatal counselling. There does not appear to be a link between the volume of the ventricular system or brain volume and the risk of poor neurodevelopmental outcome.

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Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes

Pediatric Research ◽

10.1038/s41390-021-01521-7 ◽

2021 ◽

Author(s):

Rachel L. Leon ◽

Imran N. Mir ◽

Christina L. Herrera ◽

Kavita Sharma ◽

Catherine Y. Spong ◽

...

Keyword(s):

Brain Development ◽

Congenital Heart ◽

Fetal Brain ◽

In Utero ◽

Structure And Function ◽

Brain Growth ◽

Neurodevelopmental Outcomes ◽

Fetal Brain Development ◽

And Function

Abstract Children with congenital heart disease (CHD) are living longer due to effective medical and surgical management. However, the majority have neurodevelopmental delays or disorders. The role of the placenta in fetal brain development is unclear and is the focus of an emerging field known as neuroplacentology. In this review, we summarize neurodevelopmental outcomes in CHD and their brain imaging correlates both in utero and postnatally. We review differences in the structure and function of the placenta in pregnancies complicated by fetal CHD and introduce the concept of a placental inefficiency phenotype that occurs in severe forms of fetal CHD, characterized by a myriad of pathologies. We propose that in CHD placental dysfunction contributes to decreased fetal cerebral oxygen delivery resulting in poor brain growth, brain abnormalities, and impaired neurodevelopment. We conclude the review with key areas for future research in neuroplacentology in the fetal CHD population, including (1) differences in structure and function of the CHD placenta, (2) modifiable and nonmodifiable factors that impact the hemodynamic balance between placental and cerebral circulations, (3) interventions to improve placental function and protect brain development in utero, and (4) the role of genetic and epigenetic influences on the placenta–heart–brain connection. Impact Neuroplacentology seeks to understand placental connections to fetal brain development. In fetuses with CHD, brain growth abnormalities begin in utero. Placental microstructure as well as perfusion and function are abnormal in fetal CHD.

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Clinical applications of 3D volume MR imaging of the fetal brain in utero

Prenatal Diagnosis ◽

10.1002/pd.5042 ◽

2017 ◽

Vol 37 (6) ◽

pp. 556-565 ◽

Cited By ~ 4

Author(s):

Deborah Jarvis ◽

Paul D. Griffiths

Keyword(s):

Mr Imaging ◽

Fetal Brain ◽

In Utero ◽

Clinical Applications ◽

3D Volume

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Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy

Cancers ◽

10.3390/cancers12123623 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3623

Author(s):

Anna-Maria Korakiti ◽

Eleni Zografos ◽

Mathilde van Gerwen ◽

Frédéric Amant ◽

Meletios-Athanasios Dimopoulos ◽

...

Keyword(s):

Large Scale ◽

Infant Development ◽

Neurodevelopmental Outcome ◽

Fetal Brain ◽

In Utero ◽

Chemotherapeutic Agents ◽

In Utero Exposure ◽

Cancer Management ◽

Anti Cancer

Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from the literature regarding the effect of prenatal exposure to chemotherapy on fetal brain growth and child development. All eligible studies are based on validated neurodevelopmental testing scales (e.g., Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence) and/or well-defined questionnaires. Our systematic review including 17 studies demonstrates that no major consequences on the neurodevelopment of children after in utero exposure to anti-cancer drugs have been reported; nevertheless, longer and more thorough follow-up with large-scale multicenter prospective studies is certainly required in order to draw firm conclusions.

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Effects of in-utero exposure to chemotherapy on fetal brain growth

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000416 ◽

2019 ◽

Vol 29 (7) ◽

pp. 1195-1202 ◽

Cited By ~ 1

Author(s):

Sofia Passera ◽

Valeria Contarino ◽

Giovanna Scarfone ◽

Elisa Scola ◽

Camilla Fontana ◽

...

Keyword(s):

Brain Mri ◽

Neurodevelopmental Outcome ◽

Fetal Brain ◽

In Utero ◽

Brain Atlas ◽

Brain Growth ◽

Brain Volumes ◽

Postmenstrual Age ◽

The Mean ◽

The Impact

ObjectiveChildren exposed to chemotherapy in the prenatal period demonstrate normal neurocognitive development at 3 years but concerns regarding fetal brain growth remain high considering its vulnerability to external stimuli. Our aim was to evaluate the impact of in-utero chemotherapy exposure on brain growth and its effects on neurodevelopmental outcome.MethodsThe protocol was approved by the local ethics committee. Brain regional volumes at term postmenstrual age were measured by MRI in children exposed to in-utero chemotherapy and compared with normal MRI controls. Brain segmentation was performed by Advanced Normalization Tools (ANTs)-based transformations of the Neonatal Brain Atlas (ALBERT). Neurodevelopmental assessment (Bayley-III scales) was performed at 18 months corrected age in both exposed infants and in a group of healthy controls. Multiple linear regressions and false discovery rate correction for multiple comparisons were performed.ResultsTwenty-one newborns prenatally exposed to chemotherapy (epirubicin administered in 81% of mothers) were enrolled in the study: the mean gestational age was 36.4±2.4 weeks and the mean birthweight was 2,753±622 g. Brain MRI was performed at mean postmenstrual age of 41.1±1.4 weeks. No statistically significant differences were identified between the children exposed to chemotherapy and controls in both the total (398±55 cm3 vs 427±56 cm3, respectively) and regional brain volumes. Exposed children showed normal Bayley-III scores (cognitive 110.2±14.5, language 99.1±11.3, and motor 102.6±7.3), and no significant correlation was identified between the brain volumes and neurodevelopmental outcome.ConclusionPrenatal exposure to anthracycline/cyclophosphamide-based chemotherapy does not impact fetal brain growth, thus supporting the idea that oncological treatment in pregnant women seems to be feasible and safe for the fetus.

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In Utero Administration of Drugs Targeting Microglia Improves the Neurodevelopmental Outcome Following Cytomegalovirus Infection of the Rat Fetal Brain

Frontiers in Cellular Neuroscience ◽

10.3389/fncel.2018.00055 ◽

2018 ◽

Vol 12 ◽

Cited By ~ 3

Author(s):

Robin Cloarec ◽

Sylvian Bauer ◽

Natacha Teissier ◽

Fabienne Schaller ◽

Hervé Luche ◽

...

Keyword(s):

Cytomegalovirus Infection ◽

Neurodevelopmental Outcome ◽

Fetal Brain ◽

In Utero

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Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

CNS Spectrums ◽

10.1017/s1092852916000699 ◽

2016 ◽

Vol 22 (3) ◽

pp. 273-281 ◽

Cited By ~ 4

Author(s):

Salvatore Gentile ◽

Maria Luigia Fusco

Keyword(s):

Case Reports ◽

Neurodevelopmental Outcome ◽

Case Series ◽

In Utero ◽

Small Sample ◽

Google Scholar ◽

Primary Data ◽

Published Data ◽

Medical Subject Headings ◽

Neurodevelopmental Outcomes

The proportion of pregnancies exposed to either second-generation antipsychotics (SGAs) or first-generation antipsychotics (FGAs) varies between 0.3%–2% of all pregnancies, but, until now, little is known about the potential neurobehavioral teratogenicity of antipsychotics. Assessing this safety facet is the aim of this article. PubMed, Scopus, and Google Scholar were searched for eligible articles. PubMed (1954 to May 2016) was searched using several medical subject headings, variously combined. PubMed search results were also limited using the search filter for human studies published in English. Scopus and Google Scholar searches were filtered for article title (antipsychotics/neuroleptics, pregnancy). After excluding duplicates, 9,250 articles were identified and 29 met the following inclusion criteria: only articles that provided original/primary data on neurodevelopmental outcome in human offspring older than 4 months of age, independently of the study design, were selected for review. Indeed, some relevant neurodevelopmental milestones are achieved at this time. Length of study and neurodevelopmental assessment methodology did not influence the study selection. Unfortunately, published data on neurodevelopmental teratogenicity of SGAs mainly derive from case reports and small case-series studies. Even findings emerging from case-control and prospective/retrospective studies are of limited clinical relevance because of their small sample sizes. Limited data are also available on FGAs. Hence, we have to conclude that the long-term neurodevelopmental outcomes for children exposed in utero remain unclear. Low to very low quality evidence of retrieved data makes impossible to confirm or exclude potential long-lasting untoward effects on infant neurocognitive development associate with antenatal exposure to either SGAs or FGAs.

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Effects of in utero endotoxemia on the ovine fetal brain A model for schizophrenia

Frontiers in Bioscience ◽

10.2741/e588 ◽

2012 ◽

Vol E4 (8) ◽

pp. 2745-2753 ◽

Cited By ~ 4

Author(s):

Boris W Kramer

Keyword(s):

Fetal Brain ◽

In Utero ◽

Ovine Fetal

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Optimising neurodevelopmental and psychosocial outcomes for survivors with CHD: a research agenda for the next decade

Cardiology in the Young ◽

10.1017/s1047951121002171 ◽

2021 ◽

pp. 1-3

Author(s):

Erica Sood ◽

Jeffrey P Jacobs ◽

Bradley S Marino

Keyword(s):

Health Disparities ◽

Outcomes Research ◽

Research Agenda ◽

Clinical Care ◽

Neurodevelopmental Outcome ◽

Psychosocial Outcomes ◽

The United States ◽

Future Research ◽

Neurodevelopmental Outcomes ◽

Working Groups

Abstract Neurodevelopmental and psychosocial impairments negatively impact health-related quality of life for survivors with CHD and complicate the transition to independent adulthood. Risk for neurodevelopmental and psychosocial impairments is influenced by a complex interplay among genetic, foetal, surgical, perioperative, family, and social factors, requiring a multi-pronged approach to neuroprotection and intervention. To ensure future research can ultimately reduce the burden of CHD for individuals, families, and society, the most pressing issues in cardiac neurodevelopment requiring scientific investigation must be identified. Through funding from an R13 Grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health of the United States of America, the Cardiac Neurodevelopmental Outcome Collaborative convened a two-day meeting of international experts in cardiac neurodevelopmental and psychosocial research, clinical care, and health disparities, including patient and family stakeholders, to define the cardiac neurodevelopmental and psychosocial outcomes research agenda for the next decade. Seven multidisciplinary working groups were formed to address key domains crucial to the advancement of cardiac neurodevelopmental and psychosocial outcomes research: 1) Foetal Brain Development and Neuroprotection, 2) Surgical/Perioperative Neuroprotection and Neurodevelopment, 3) Characterization of Neurodevelopmental and Psychological Outcomes, 4) Neurodevelopmental and Psychosocial Intervention, 5) Parent Mental Health and Family Functioning, 6) Neurodevelopmental Education, Outreach and Advocacy, and 7) Health Disparities and Neurodevelopmental Outcomes. Working groups identified significant gaps in knowledge and critical questions that must be answered to further knowledge, policy, care, and outcomes. The development of a research agenda in cardiac neurodevelopmental and psychosocial outcomes is critical for informing collaborative initiatives and allocation of funding for research to scientific inquiries of highest value to key stakeholders.

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