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Neuroimaging and neurodevelopmental outcome after early fetal growth restriction: NEUROPROJECT-FGR
Gloria Brembilla1, Andrea Righini2, Barbara Scelsa3
1Department of Woman, Mother and Child, Buzzi Hospital, University of Milan, via Castelvetro 32, 20154, Milan, Italy. gloria.brembilla@unimi.it.
Insights
Fetal growth restriction (FGR) in infants leads to smaller brain parenchymal areas, impacting cognitive scores. Early MRI evaluations can identify high-risk infants, even without overt brain lesions.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Infants born after fetal growth restriction (FGR) exhibit adverse neurodevelopmental outcomes and brain alterations on MRI.
- Prematurity is a known risk factor for impaired brain development.
Purpose of the Study:
- To evaluate the additional role of FGR, beyond prematurity, in determining brain impairment in preterm infants.
- To investigate the relationship between structural brain measurements and neurodevelopmental outcomes in FGR infants.
Main Methods:
- Retrospective observational study comparing 48 FGR and 36 appropriate for gestational age infants born between 26-32 weeks' gestation.
- Cerebral MRI at term equivalent age to assess total maturation score (TMS) and cerebral areas.
- Neurodevelopmental assessment using Griffiths or Bayley scale III at median age of 2 years.
Main Results:
- Significantly smaller inner calvarium and parenchyma areas were observed in FGR infants compared to controls.
- No significant differences in total maturation scores or average quotient scores between groups.
- A positive correlation was found between parenchyma area and cognitive score, even after adjusting for confounding factors.
Conclusions:
- Fetal growth restriction plays an additional role in determining brain impairment beyond prematurity.
- Structural dimensional MRI evaluation can identify preterm infants at higher risk for neurodevelopmental issues, even without overt brain lesions.
Background:
Adverse neurodevelopmental outcomes and MRI alterations are reported in infants born after fetal growth restriction (FGR). This study evaluates the additional role of FGR over prematurity in determining brain impairment.
Methods:
Retrospective observational study comparing 48 FGR and 36 appropriate for gestational age infants born between 26 and 32 weeks' gestation who underwent a cerebral MRI at term equivalent age. Exclusion criteria were twins, congenital anomalies, and findings of overt brain lesions. Main outcomes were total maturation score (TMS) and cerebral areas independently measured by two neuro-radiologists and Griffiths or Bayley scale III scores at median age of 2 years.
Results:
TMS was not significantly different between the groups. Inner calvarium and parenchyma's areas were significantly smaller in FGR cases. There were no significant differences in the average quotient scores. A positive correlation between parenchyma area and cognitive score was found (r = 0.372, p = 0.0078) and confirmed after adjusting for sex, gestational age, and birth weight (p = 0.0014). Among FGR, the subgroup with umbilical arterial Doppler velocimetry alterations had significantly worse gross motor scores (p = 0.005).
Conclusions:
FGR plays additional role over prematurity in determining brain impairment. An early structural dimensional MRI evaluation may identify infants who are at higher risk.
Impact:
Fetal growth-restricted infants showed smaller cerebral parenchymal areas than preterm controls. There is a positive correlation between the parenchyma area and the cognitive score. These results highlight the already known link between structure and function and add importance to the role of a structural dimensional MRI evaluation even in the absence of overt brain lesions.
