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Neonatal Follow-up

NICU Follow Up and Neurodevelopment 3: Impact of the Prenatal Environment on Development and Outcomes

227 - Association of prenatal brain immaturity with postnatal neurodevelopmental outcomes in patients with congenital diaphragmatic hernia

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 227
Publication Number: 227.143

Sandy Johng, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Enrico Danzer, CHOP, Philadelphia, PA, United States; Casey Hoffman, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Leny Mathew, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sabrina Flohr, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Daniel Licht, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Shavonne Massey, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Holly L. Hedrick, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Juliana Gebb, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Presenting Author(s)

Sandy Johng, MD (she/her/hers)

Clinical Attending and Research Fellow
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Background: Patients with congenital diaphragmatic hernia (CDH) have delayed prenatal brain maturation according to the fetal Total Maturation Score (fTMS). Currently, there are no studies that demonstrate an association between prenatal neuroimaging and postnatal neurodevelopmental outcomes in patients with CDH.

Objective: To investigate the association between prenatal brain maturation and postnatal neurodevelopmental outcomes in patients with CDH.

Design/Methods: We conducted a retrospective observational study using data from a quaternary single-center clinical registry. Neonates with prenatal neuroimaging obtained between 2014 and 2020 were included for fTMS generation (N=48). Survivors from this cohort who had at least one postnatal neurodevelopmental assessment were included. The fTMS difference, defined as the calculated gestational age (GA) from the fTMS minus the actual GA, provides a measure of prenatal brain maturation such that a negative value indicates prenatal brain immaturity. The association between the fTMS difference and the Bayley Scales of Infant Development-III (BSID-III) composite cognitive, motor, and language scores was assessed with linear regression models, separated by age < or >12 months, and adjusted for treatment with extracorporeal membrane oxygenation (ECMO). If a patient had multiple neurodevelopmental visits, the latest date was chosen within the strata of < or >12 months.

Results: Twenty-six of 31 (84%) survivors had BSID-III assessments (Table 1). We observed a statistically significant association between the fTMS difference and the composite language score at >12 months. A one-unit increase in the fTMS difference was associated with a 6.5-point increase in the language score after adjusting for treatment with ECMO (unadjusted: 6.68, 95% CI 2.05 – 11.31, p-value < 0.01; adjusted: 6.53, 95% CI 1.77 – 11.29, p-value < 0.01) (Figure 1). There was no significant association between the fTMS difference and language scores at < 12 months, or cognitive or motor scores at < or >12 months.

Conclusion(s): Prenatal brain immaturity in patients with CDH is associated with language scores in early childhood. This is the first study to demonstrate an association between prenatal neuroimaging and postnatal neurodevelopmental outcomes in patients with CDH. Our findings suggest that risk for neurodevelopmental impairment in this population may begin in utero.