Related Experiment Video
Updated: Jan 18, 2026
Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
Early Magnetic Resonance Imaging Predicts 12-Month Outcome in Neonates with Congenital Diaphragmatic Hernia
Anne Christin Ulrike Groteklaes1, Till Dresbach1, Florian Kipfmüller1,2
1Department of Neonatology and Pediatric Intensive Care, Children's Hospital University of Bonn, Bonn, Germany.
Insights
Magnetic resonance imaging (MRI) abnormalities are common in congenital diaphragmatic hernia (CDH) survivors. A new, simple MRI scoring system can predict long-term neurological outcomes in these infants.
Area of Science:
- Neonatal neurology
- Pediatric radiology
- Congenital abnormalities
Background:
- Congenital diaphragmatic hernia (CDH) prognosis has improved, but long-term neurological morbidity remains a concern for survivors.
- Magnetic resonance imaging (MRI) abnormalities are frequent in CDH survivors, yet their correlation with neurodevelopmental outcomes needs further investigation.
Purpose of the Study:
- To determine if postnatal MRI assessment in CDH survivors can be associated with and predict long-term neurological outcomes.
- To evaluate the utility of the Weeke score and develop a novel MRI scoring system for outcome prediction.
Main Methods:
- Brain MRI was conducted on 36 neonates with CDH, utilizing the Weeke score to assess specific brain structures.
- Neurodevelopmental outcomes were evaluated at 12 months using Bayley-III examinations.
Main Results:
- Over 91% of neonates showed MRI abnormalities, including white matter (83.3%) and gray matter (16.6%) pathologies, and intracranial hemorrhage (20%).
- Specific abnormalities like abnormal mammillary bodies (30.5%) and enlarged cerebrospinal fluid (CSF) spaces (44.4%) were noted.
- A novel, easy-to-perform MRI scoring system effectively predicted adverse neurological outcomes at 12 months, outperforming the Weeke score.
Conclusions:
- Interpretation of neonatal CDH MRIs should prioritize white matter pathologies, CSF enlargement, internal capsule, mammillary body abnormalities, and intraventricular hemorrhage.
- A new simple MRI scoring system can identify neonates at risk for adverse neurological outcomes, enabling early therapeutic interventions.
Introduction:
Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of long-term neurological morbidity. Magnetic resonance imaging (MRI) abnormalities are reported in up to 84% of CDH survivors but have only been rarely compared with neurodevelopmental outcomes. This study aims to investigate whether assessment of postnatal MRI in CDH survivors allowed association with and prediction of long-term outcome.
Methods:
Brain MRI was performed in 36 neonates with CDH using the Weeke score, assessing the mammillary bodies, the corpus callosum, cortical folding, and cerebrospinal fluid space (CSF). Outcomes were measured using Bayley-III-examinations at 12 months.
Results:
In total, 91.6% of the neonates exhibited MRI abnormalities. Among them, 83.3% showed white matter (WM), 16.6% gray matter abnormalities, 8.3% cerebellar abnormalities, and 20% had an intracranial hemorrhage. A total of 30.5% showed abnormal mammillary bodies, 44.4% enlarged CSF, 5.5% reduced cortical folding, and 8.3% reduced corpus callosum thickness. While the use of the Weeke score was not helpful for outcome prediction, specific MRI abnormalities were associated with adverse long-term outcomes. Based on these findings, a novel MRI-scoring system was developed. This easy-to-perform score effectively predicted adverse outcomes at 12 months.
Conclusion:
Interpretation of MRI in neonates with CDH should focus on WM pathologies, CSF enlargement, internal capsule involvement, mammillary body abnormalities, and intraventricular hemorrhage. Our novel simple scoring system helps identify neonates at risk for adverse neurological outcomes at discharge and aids to implement therapeutic strategies at an early point.
