Fetal surgery has no additional effect to general anesthesia on brain development in neonatal rabbits

Veeken, Lennart Van der; Emam, Doaa; Bleeser, Tom; Valenzuela, Ignacio; Merwe, Johannes van der; Rex, Steffen; Deprest, Jan

doi:10.1016/j.ajogmf.2021.100513

Cited by 2 publications

(2 citation statements)

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“…Because we previously demonstrated that fetal surgery has no additional effects to general anesthesia on brain development in neonatal rabbits, we did not include a sham group. 45 Rabbits are also a relevant model for assessment of fetal and neonatal brain development. In rabbits, brain development peaks around birth as in humans.…”

Section: Strengths and Limitations And Research Implicationsmentioning

confidence: 99%

Brain development is altered in rabbit fetuses with congenital diaphragmatic hernia

et al. 2023

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Introduction:Children with congenital diaphragmatic hernia (CDH) are at risk for neurodevelopmental delay. Some changes are already present prenatally. Herein, we further examined how the brain develops in fetal rabbits with surgically created DH. Methods: Two fetuses underwent surgical DH creation on day 23 (term = d31). DH pups and littermate controls were harvested at term. Ten DH pups and 11 controls underwent transcardial perfusion for brain fixation and measurement of brain volume, brain folding, neuron and synaptic density, pre-oligodendrocyte count, proliferation, and vascularization. Twelve other DH and 11 controls had echocardiographic assessment of cardiac output and aortic and cerebral blood flow, magnetic resonance imaging (9.4 T) for cerebral volumetry, and molecular assessment of vascularization markers.Results: DH pups had lower lung-to-body weight ratio (1.3 � 0.3 vs. 2.4 � 0.3%; p < 0.0001) and lower heart-to-body weight ratio (0.007 � 0.001 vs. 0.009 � 0.001; p = 0.0006) but comparable body weight and brain-to-body weight ratio. DH pups had a lower left ventricular ejection fraction, aortic and cerebral blood flow (39 � 8 vs. 54 � 15 mm/beat; p = 0.03) as compared to controls but similar left cardiac ventricular morphology. Fetal DH-brains were similar in volume but the cerebellum was less folded (perimeter/surface area: 25.5 � 1.5 vs.26.8 � 1.2; p = 0.049). Furthermore, DH brains had a thinner cortex (143 � 9 vs. 156 � 13 μm; p = 0.02). Neuron densities in the white matter were higher in DH fetuses (124 � 18 vs. 104 � 14; p = 0.01) with comparable proliferation rates.Pre-oligodendrocyte count was lower, coinciding with the lower endothelial cell count. Conclusion:Rabbits with DH had altered brain development compared to controls prenatally, indicating that brain development is already altered prenatally in CDH.This study was performed at the KU Leuven, Belgium.

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Section: Strengths and Limitations And Research Implicationsmentioning

confidence: 99%

Brain development is altered in rabbit fetuses with congenital diaphragmatic hernia

et al. 2023

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“…The safety for the unaffected twin of using volatile agents during anesthesia is uncertain 22,23 . However, in animal models, maternal general anesthesia did not affect brain development of non‐operated pups 20,24 . Therefore, we counseled our patients that the risk to the unaffected twin associated with the anesthetic should be similar to that of laparoscopic surgery during pregnancy (which has been shown to carry no additional risk to the fetus 25 ).…”

Section: Discussionmentioning

confidence: 99%

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

Lapa

Acácio

Trigo

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveTwin pregnancy is currently an exclusion criterion for the prenatal repair of open spina bifida. The objective of this study was to report our experience in the treatment of twin pregnancies using the SAFER technique for repair. We also discuss the rationale of currently exclusion criteria for fetal spina bifida repair.MethodsWe have successfully repaired eight affected fetuses in seven twin pregnancies. Six were dichorionic with only one twin affected, and one was monochorionic with both twins affected. Percutaneous fetoscopy was performed under CO2 insufflation in the sac of the affected twin. Neurosurgical repair was performed using a biocellulose patch to protect the placode and skin suture to hold the patch in place, with or without a myofascial flap. Neurodevelopment was assessed by the PEDI scale in babies older than 6 months and Alberta scale below 6 months of corrected age.ResultsFourteen fetuses were liveborn, of which eight presented open spina bifida. None required any additional repair. Gestational age at surgery varied from 27.3 to 31.1 weeks and gestational age at birth varied from 31.6 to 36.0 weeks. Sequalae of prematurity was not found in any of the unaffected twins and their short‐term neurodevelopment was normal, assessed at a median chronological age of 12.5 (interquartile range, 2.7‐18.1) months. In the affected group, only one baby had a ventricle‐peritoneal shunt placed.ConclusionsPrematurity is frequent after fetal surgery, and the risk is increased in twin pregnancies. Nevertheless, prenatal surgery using the SAFER technique is feasible with low risk to both twins and their mother, when performed by a highly experienced team. Long‐term cognitive assessment of the unaffected twin is needed.This article is protected by copyright. All rights reserved.

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Fetal surgery has no additional effect to general anesthesia on brain development in neonatal rabbits

Cited by 2 publications

References 35 publications

Brain development is altered in rabbit fetuses with congenital diaphragmatic hernia

Brain development is altered in rabbit fetuses with congenital diaphragmatic hernia

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

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