Prenatal Brain Maturation is Delayed in Neonates with Congenital Diaphragmatic Hernia.

Autor: Johng S; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: johngs@chop.edu., Licht DJ; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA., Hedrick HL; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA., Rintoul N; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA., Linn RL; Division of Anatomic Pathology, Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA., Gebb JS; Richard D Wood, Jr Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA., Xiao R; Department of Biostatistics, Epidemiology, and Informatics, Hospital of the University of Pennsylvania, Philadelphia, PA., Massey SL; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2024 Jan; Vol. 264, pp. 113738. Date of Electronic Publication: 2023 Sep 16.
DOI: 10.1016/j.jpeds.2023.113738
Abstrakt: 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 and 2020 and prenatal brain magnetic resonance imaging (MRI) (n = 48) were included. We compared our study sample with historical healthy controls (n = 48). The relationship between fTMS and gestational age (GA), 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 <.001). Within the CDH cohort, there was no significant difference in fTMS based on CDH severity, intrathoracic liver position, right vs left CDH, sex, presence of abnormal echocardiogram findings, treatment with extracorporeal membrane oxygenation (ECMO), 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 = .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.
Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest. No funding was received for this study.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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