Abstract
We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA.
Highlights
In humans, the period between the third trimester of gestation and the second year of life represents a critical phase of neurodevelopment with long-term implications for cognitive and behavioral function [1,2,3]
We previously showed clinically significant MRI findings [16,17], increased cerebrospinal fluid (CSF) volume [16] and globally decreased brain size [18] in critically ill premature and full-term infants after long-gap esophageal atresia (LGEA) repair using the Foker process [19,20,21]
We present three preterm and three full-term infants treated with the Foker process requiring complex perioperative critical care
Summary
The period between the third trimester of gestation and the second year of life represents a critical phase of neurodevelopment with long-term implications for cognitive and behavioral function [1,2,3]. The importance of this phase is emphasized by dramatic brain growth, synaptogenesis, and myelination, with cognitive and motor development following . Brain Sci. 2019, 9, 383 insult can alter the developmental trajectory, resulting in potential consequences ranging from delayed acquisition of function to severe neurological disorder [4,5]. The need to undergo major surgical procedures presents a source of significant pain in addition to metabolic, hemodynamic, and respiratory stress [9]
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