Neonatology · 2025
Early Magnetic Resonance Imaging Predicts 12-Month Outcome in Neonates with Congenital Diaphragmatic Hernia.
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Groteklaes Anne Christin Ulrike, Dresbach Till, Kipfmueller Florian, Stutte Sonja, Bagci Soyhan, Grass Tamara, Nitsch-Felsecker Patrizia, Pantazis Christos, Schmitt Joachim, Schroeder Lukas, Mueller Andreas, de Vries Linda S, Sabir Hemmen
Аннотация
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.
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.