843: Prenatal brain growth is altered in Congenital Diaphragmatic Hernia on ultrasound

Abstract

To describe ultrasound brain biometry and brain perfusion in a cohort of Congenital Diaphragmatic Hernia fetuses. This is a multicenter retrospective study of fetuses with isolated left sided CDH assessed in three European fetal surgery centers: London (UK), Barcelona (Spain) and Leuven (Belgium). Included were all cases with longitudinal data (at least three measurements within a minimum period of four weeks). Outcome measurements were Middle Cerebral Artery (MCA) Doppler, Head Circumference (HC), TransCerebellar diameter (TCD), Observed-to-expected lung-to-head ratio (o/e LHR) and liver position. We included 176 cases. HC Z-score were within normal range throughout gestation but different from average towards the end of pregnancy (p< 0,0001). Average growth was increased (R2= 0.92; p< 0,0001). TCD Z-scores were normal at 20 weeks but 55% of measurements were abnormal beyond 32 weeks (p< 0.0001). The average growth curve had a different pattern compared to normal and fell below the 5th centile from 32 weeks onwards (R2= 0.80; p< 0.0001; Figure). The pulsatility index in the MCA Doppler was normal but the peak systolic velocity (PSV) was consistently 20% lower than normal (p< 0,0001). Liver herniation was correlated to lower PSV (p=0.002). Fetoscopic endoluminal tracheal occlusion (FETO) did not influence HC, TCD and MCA measurements. Fetal brain growth and perfusion is altered in isolated left sided CDH. The growth pattern of the cerebellum is different from the normal, falling below normal ranges by 32 weeks. Accordingly, lower PSV values in the MCA were found.View Large Image Figure ViewerDownload Hi-res image Download (PPT)