Correlation of MRI Brain Injury Findings with Neonatal Clinical Factors in Infants with Congenital Diaphragmatic Hernia.

R. Radhakrishnan,E. Zorn,B. Kline-Fath,J. Meinzen-Derr,B. Haberman,S. Merhar,P. Burns,F.Y. Lim

doi:10.3174/ajnr.a4787

Abstract

Infants with congenital diaphragmatic hernia are reported to have evidence of brain MR imaging abnormalities. Our study aimed to identify perinatal clinical factors in infants with congenital diaphragmatic hernia that are associated with evidence of brain injury on MR imaging performed before hospital discharge. MRIs performed before hospital discharge in infants with congenital diaphragmatic hernia were scored for brain injury by 2 pediatric neuroradiologists. Perinatal variables and clinical variables from the neonatal intensive care unit stay were analyzed for potential associations with brain MR imaging findings. Fifty-three infants with congenital diaphragmatic hernia (31 boys) were included. At least 1 abnormality was seen on MR imaging in 32 infants (60%). The most common MR imaging findings were enlarged extra-axial spaces (36%), intraventricular hemorrhage (23%), ventriculomegaly (19%), white matter injury (17%), and cerebellar hemorrhage (17%). The MR imaging brain injury score was associated with extracorporeal membrane oxygenation (P = .0001), lack of oral feeding at discharge (P = .012), use of inotropes (P = .027), and gastrostomy tube placement before hospital discharge (P = .024). The MR imaging brain injury score was also associated with a large diaphragmatic defect size (P = .011). Most infants with congenital diaphragmatic hernia have at least 1 abnormality identified on MR imaging of the brain performed before discharge. The main predictors of brain injury in this population are a requirement for extracorporeal membrane oxygenation, large diaphragmatic defect size, and lack of oral feeding at discharge.

Highlights

BACKGROUND AND PURPOSEInfants with congenital diaphragmatic hernia are reported to have evidence of brain MR imaging abnormalities
The MR imaging brain injury score was associated with extracorporeal membrane oxygenation (P ϭ .0001), lack of oral feeding at discharge (P ϭ .012), use of inotropes (P ϭ .027), and gastrostomy tube placement before hospital discharge (P ϭ .024)
The main predictors of brain injury in this population are a requirement for extracorporeal membrane oxygenation, large diaphragmatic defect size, and lack of oral feeding at discharge

Summary

Methods

MRIs performed before hospital discharge in infants with congenital diaphragmatic hernia were scored for brain injury by 2 pediatric neuroradiologists. Perinatal variables and clinical variables from the neonatal intensive care unit stay were analyzed for potential associations with brain MR imaging findings. We included infants with CDH with MR imaging of the brain before discharge as described in the flow chart (Fig 1). MR imaging was performed on these infants on 1.5T and 3T, and with a small-bore extremity 1.5T MR imaging scanner that was adapted for neonatal imaging in the neonatal intensive care unit.[12] MR imaging was performed without sedation after feeding and swaddling, except when excessive motion required light sedation. The MR images were independently reviewed by 2 pediatric neuroradiologists who were blinded to the clinical variables except for postmenstrual age at the time of MR imaging. The total brain injury score was calculated in each infant.

Results

Discussion

Conclusion