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Correlation of MRI Brain Injury Findings with Neonatal Clinical Factors in Infants with Congenital Diaphragmatic
R Radhakrishnan1, S Merhar2, J Meinzen-Derr3
1From the Departments of Radiology (R.R., B.K.-F.) rupa.radhakrishnan@cchmc.org.
Insights
Most infants with congenital diaphragmatic hernia show brain abnormalities on MRI. Key predictors of brain injury include extracorporeal membrane oxygenation, large diaphragmatic defects, and inability to feed orally at discharge.
Area of Science:
- Pediatric Radiology
- Neonatal Neurology
- Congenital Abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) is associated with brain MR imaging abnormalities in infants.
- Understanding perinatal factors linked to brain injury is crucial for managing CDH patients.
Purpose of the Study:
- To identify perinatal clinical factors associated with brain injury in infants with CDH.
- To correlate clinical data with brain MR imaging findings before hospital discharge.
Main Methods:
- Retrospective analysis of brain MRIs in 53 infants with CDH.
- Scoring of brain injury by two pediatric neuroradiologists.
- Association analysis between perinatal/clinical variables and MR imaging findings.
Main Results:
- 60% of infants with CDH had at least one brain abnormality on MRI.
- Common findings included enlarged extra-axial spaces, intraventricular hemorrhage, and white matter injury.
- Brain injury score correlated with extracorporeal membrane oxygenation, lack of oral feeding, inotrope use, gastrostomy tube, and large diaphragmatic defect size.
Conclusions:
- The majority of infants with CDH exhibit brain abnormalities on pre-discharge MRI.
- Extracorporeal membrane oxygenation, large diaphragmatic defect size, and absence of oral feeding are significant predictors of brain injury.
Background And Purpose:
Infants with congenital diaphragmatic hernia are reported to have evidence of brain MR imaging abnormalities. Our study aimed to identify perinatal clinical factors in infants with congenital diaphragmatic hernia that are associated with evidence of brain injury on MR imaging performed before hospital discharge.
Materials And Methods:
MRIs performed before hospital discharge in infants with congenital diaphragmatic hernia were scored for brain injury by 2 pediatric neuroradiologists. Perinatal variables and clinical variables from the neonatal intensive care unit stay were analyzed for potential associations with brain MR imaging findings.
Results:
Fifty-three infants with congenital diaphragmatic hernia (31 boys) were included. At least 1 abnormality was seen on MR imaging in 32 infants (60%). The most common MR imaging findings were enlarged extra-axial spaces (36%), intraventricular hemorrhage (23%), ventriculomegaly (19%), white matter injury (17%), and cerebellar hemorrhage (17%). The MR imaging brain injury score was associated with extracorporeal membrane oxygenation (P = .0001), lack of oral feeding at discharge (P = .012), use of inotropes (P = .027), and gastrostomy tube placement before hospital discharge (P = .024). The MR imaging brain injury score was also associated with a large diaphragmatic defect size (P = .011).
Conclusions:
Most infants with congenital diaphragmatic hernia have at least 1 abnormality identified on MR imaging of the brain performed before discharge. The main predictors of brain injury in this population are a requirement for extracorporeal membrane oxygenation, large diaphragmatic defect size, and lack of oral feeding at discharge.
