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Published on: June 29, 2013
Prenatal cerebellar growth is altered in congenital diaphragmatic hernia on ultrasound
Lennart Van der Veeken1,2, Francesca M Russo1,2, Ewelina Litwinska3
1Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.
Insights
Fetuses with congenital diaphragmatic hernia (CDH) show a smaller cerebellum and reduced brain blood flow. These prenatal findings in CDH may impact neurodevelopmental outcomes.
Area of Science:
- Fetal Medicine
- Pediatric Neurology
- Medical Imaging
Background:
- Congenital diaphragmatic hernia (CDH) poses a risk for neurodevelopmental delays in affected children.
- Prenatal assessment of fetal development is crucial for understanding potential long-term outcomes.
Purpose of the Study:
- To investigate prenatal biometry and brain perfusion changes in fetuses diagnosed with isolated congenital diaphragmatic hernia (CDH).
- To establish normative growth curves and identify deviations in specific fetal measurements.
Main Methods:
- Retrospective analysis of 367 fetuses with isolated left-sided CDH across three European centers.
- Longitudinal assessment of head circumference (HC), abdominal circumference (AC), femur length (FL), transcerebellar diameter (TCD), middle cerebral artery (MCA) Doppler, and ventricular width (VW) at different gestational periods.
- Calculation of Z-scores and creation of growth curves.
Main Results:
- While HC, AC, and FL remained within normal ranges, TCD and ventricular width showed a trend of decreasing with gestational age, falling below the fifth percentile after 32 weeks.
- Middle cerebral artery (MCA) peak systolic velocity was consistently reduced by approximately 10%.
- Disease severity correlated significantly with TCD and MCA Doppler values (p=0.002 for both). No differences were observed between fetuses treated with fetoscopic endoluminal tracheal occlusion (FETO) and those managed expectantly.
Conclusions:
- Fetuses with isolated left-sided CDH exhibit a smaller cerebellum (TCD) and reduced cerebral blood flow (MCA peak systolic velocity) prenatally.
- These observed fetal biometric and perfusion changes warrant further investigation to determine their impact on neurodevelopmental outcomes in children with CDH.
Objective:
Children with congenital diaphragmatic hernia (CDH) are at risk for neurodevelopmental delay. Herein we report on prenatal changes in biometry and brain perfusion in fetuses with isolated CDH.
Study Design:
This retrospective study evaluated fetuses with isolated, left-sided CDH in three European referral centers. Abdominal circumference (AC), femur length (FL), head circumference (HC), transcerebellar diameter (TCD), middle cerebral artery (MCA) Doppler, and ventricular width (VW) were assessed during four gestational periods (<24 weeks, 25-28 weeks, 29-32 weeks, >33 weeks). Z-scores were calculated, and growth curves were created based on longitudinal data.
Results:
In 367 fetuses, HC, AC and FL were within normal ranges throughout gestation. The TCD diminished with advancing gestational age to fall below the fifth percentile after 32 weeks. A less pronounced but similar trend was seen in VW. The peak systolic velocity of the MCA was consistently approximately 10% lower than normal. Disease severity was correlated to TCD (p = 0.002) and MCA doppler values (p = 0.002). There were no differences between fetuses treated with FETO and those managed expectantly.
Conclusion:
Fetuses with isolated left-sided CDH have a small cerebellum and reduced MCA peak systolic velocity. Follow up studies are necessary to determine the impact of these changes on neurodevelopment.
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