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Neonatal neuroimaging after repair of congenital diaphragmatic hernia and long-term neurodevelopmental outcome
  1. Julia Kate Gunn-Charlton1,2,3,
  2. Alice C Burnett1,3,4,
  3. Stephanie Malarbi1,3,
  4. Margaret M Moran1,3,
  5. Esther A Hutchinson1,3,
  6. Susan Greaves5 and
  7. Rod W Hunt1,2,3
  1. 1Newborn Intensive Care, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  2. 2Neonatal Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4Victorian Infant Brain Studies (VIBeS) Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  5. 5Department of Occupational Therapy, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Julia Kate Gunn-Charlton; julia.gunn{at}rch.org.au

Abstract

Objective Previous 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.

Methods In 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.

Results Clinically 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.

Conclusions Neuroimaging abnormalities were associated with worse neurodevelopment at 2 years, but not with later neurocognitive outcomes, after accounting for clinical risk factors.

  • congenital diaphragmatic hernia
  • neuroimaging
  • neurodevelopment
  • neonate

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors JKGC was responsible for the study protocol, data collection, analysis, the first draft of the manuscript and oversight of the research as guarantor of the integrity of the research on behalf of all authors. ACB, SM and MMM collected and analyzed data and contributed to editing of the manuscript. EAH was responsible for the study protocol and collected data. SG contributed to the study protocol, collected data and edited the manuscript. RWH was responsible for project oversight, funding access, study protocol, data analysis and editing of the manuscript.

  • Funding The Neonatal Neurodevelopment Follow-up Clinic is funded by The Royal Children’s Hospital Foundation, Melbourne Australia.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Human Research and Ethics Committee approval was obtained for an opt-out consent process to collate clinically acquired data for research purposes.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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