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Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis
G Pagani1, B Thilaganathan, F Prefumo
1Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Spedali Civili and University of Brescia, Brescia, Italy; Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
Insights
Mild fetal ventriculomegaly (10-15 mm) has a 7.9% rate of neurodevelopmental delay. Prenatal imaging has a 7.4% false-negative rate for associated abnormalities, highlighting the need for further research.
Area of Science:
- Perinatology
- Developmental Neuroscience
- Medical Imaging
Background:
- Fetal ventriculomegaly, particularly when mild and isolated, is associated with potential neurodevelopmental concerns.
- Accurate assessment of associated abnormalities and long-term outcomes is crucial for informed clinical management.
Purpose of the Study:
- To systematically review and meta-analyze the literature on isolated mild fetal ventriculomegaly (10-15 mm).
- To determine the prevalence of neurodevelopmental delay in these cases.
- To evaluate the false-negative rate of prenatal imaging for detecting associated abnormalities.
Main Methods:
- Systematic literature search of scientific databases for studies on neurodevelopmental outcome in isolated ventriculomegaly.
- Inclusion criteria: assessment of neurodevelopmental outcome, karyotype check, and mild ventriculomegaly (10-15 mm atrial width).
- Exclusion criteria: absence of karyotype, bilateral ventriculomegaly, or pre/postnatal abnormalities.
Main Results:
- Included 20 studies with 699 cases of isolated mild fetal ventriculomegaly.
- Overall prevalence of neurodevelopmental delay was 7.9% (95% CI, 4.7-11.1%).
- Postnatal imaging in 9 studies revealed a 7.4% (95% CI, 3.1-11.8%) prevalence of previously undiagnosed findings.
Conclusions:
- The false-negative rate of prenatal imaging for associated abnormalities in isolated mild fetal ventriculomegaly (≤ 15 mm) is 7.4%.
- The incidence of neurodevelopmental delay in truly isolated mild ventriculomegaly (≤ 15 mm) is 7.9%, similar to the general population.
- Further large prospective studies are needed to assess childhood disability prevalence rather than subtle neurodevelopmental delays.
Objectives:
The finding of fetal ventriculomegaly is variably associated with other fetal abnormalities and, even when isolated, is thought to be linked to abnormal neurodevelopmental outcome. The aim of this study was to undertake a systematic review and meta-analysis of the current literature to assess the prevalence of neurodevelopmental delay in cases of isolated mild fetal ventriculomegaly, as well as the false-negative rate of prenatal imaging for the diagnosis of associated abnormalities in patients referred for isolated mild ventriculomegaly.
Methods:
Studies that assessed neurodevelopmental outcome in isolated ventriculomegaly were identified from a search of scientific databases. Studies that did not check for karyotype or that excluded cases of bilateral ventriculomegaly were not included in the analysis. Ventriculomegaly was defined as mild when the width of the ventricular atrium was between 10 and 15 mm. Cases in which an associated abnormality (abnormal karyotype, structural abnormality or fetal infection) was observed either before or after birth were not considered as part of the isolated group. Neurodevelopmental delay was defined as an abnormal quotient score, according to the test used.
Results:
The search yielded 961 possible citations; of these, 904 were excluded by review of the title or abstract as they did not meet the selection criteria. Full manuscripts were retrieved for 57 studies, and 20 were included in the review with a total of 699 cases of isolated mild ventriculomegaly. The overall prevalence of neurodevelopmental delay was 7.9% (95% CI, 4.7-11.1%). Of the 20 studies included in the systematic review, nine reported data on postnatal imaging, showing a prevalence of previously undiagnosed findings of 7.4% (95% CI, 3.1-11.8%).
Conclusions:
The false-negative rate of prenatal imaging is 7.4% in apparently isolated fetal ventriculomegaly of ≤ 15 mm. The incidence of neurodevelopmental delay in truly isolated ventriculomegaly of ≤ 15 mm is 7.9%. As the latter rate is similar to that noted in the general population, large prospective cohort studies assessing the prevalence of childhood disability, rather than subtle neurodevelopmental delay, are required.
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