Abstract
Previous studies in preterm infants report white matter abnormalities of the corpus callosum (CC) as an important predictor of neurodevelopmental outcomes. Our cross-sectional study aimed to describe qualitative and quantitative CC size in critically ill infants following surgical and critical care for long-gap esophageal atresia (LGEA) – in comparison to healthy infants – using MRI. Non-sedated brain MRI was acquired for full-term (n = 13) and premature (n = 13) patients following treatment for LGEA, and controls (n = 20) <1 year corrected age. A neuroradiologist performed qualitative evaluation of T1-weighted images. ITK-SNAP was used for linear, 2-D and 3-D manual CC measures and segmentations as part of CC size quantification. Qualitative MRI analysis indicated underdeveloped CC in both patient groups in comparison to controls. We show no group differences in mid-sagittal CC length. Although 2-D results were inconclusive, volumetric analysis showed smaller absolute (F(2,42) = 20.40, p < 0.001) and normalized (F(2,42) = 16.61, p < 0.001) CC volumes following complex perioperative treatment for LGEA in both full-term and premature patients, suggesting delayed or diminished CC growth in comparison to controls, with no difference between patient groups. Future research should look into etiology of described differences, neurodevelopmental outcomes, and role of the CC as an early marker of neurodevelopment in this unique infant population.
Highlights
Previous studies in preterm infants report white matter abnormalities of the corpus callosum (CC) as an important predictor of neurodevelopmental outcomes
In addition to prematurity, the type of congenital anomaly predicted presence of white matter lesions. Such findings might not be unique to infants with esophageal atresia, since it is known that neonates born with congenital heart defects are at risk of altered CC size pre-surgery, with such disparities intensifying following cardiac surgery and critical care[41]
Following exclusion of extremely premature infants, we report smaller absolute CC volumes in both full-term and premature patients following longgap esophageal atresia (LGEA) repair in comparison to controls (Fig. 5B,C)
Summary
Previous studies in preterm infants report white matter abnormalities of the corpus callosum (CC) as an important predictor of neurodevelopmental outcomes. In the same pilot cohort of full-term and premature patients, we illustrated qualitative MRI findings implicating abnormal thinning of the corpus callosum (CC)[6] following completion of complex perioperative critical care for LGEA that included Foker process[1,2] and prolonged postoperative sedation (≥5 days)[11]. We hypothesized that critically ill full-term and premature patients
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