Infant study of hemispheric asymmetry after long‐gap esophageal atresia repair

Abstract

Objectives Previous studies have demonstrated that infants are typically born with a left‐greater‐than‐right forebrain asymmetry that reverses throughout the first year of life. We hypothesized that critically ill term‐born and premature patients following surgical and critical care for long‐gap esophageal atresia (LGEA) would exhibit alteration in expected forebrain asymmetry. Methods Term‐born (n = 13) and premature (n = 13) patients, and term‐born controls (n = 23) <1 year corrected age underwent non‐sedated research MRI following completion of LGEA treatment via Foker process. Structural T1‐ and T2‐weighted images were collected, and ITK‐SNAP was used for forebrain tissue segmentation and volume acquisition. Data were presented as absolute (cm3) and normalized (% total forebrain) volumes of the hemispheres. All measures were checked for normality, and group status was assessed using a general linear model with age at scan as a covariate. Results Absolute volumes of both forebrain hemispheres were smaller in term‐born and premature patients in comparison to controls (p < 0.001). Normalized hemispheric volume group differences were detected by T1‐weighted analysis, with premature patients demonstrating right‐greater‐than‐left hemisphere volumes in comparison to term‐born patients and controls (p < 0.01). While normalized group differences were very subtle (a right hemispheric predominance of roughly 2% of forebrain volume), they represent a deviation from the expected pattern of hemispheric brain asymmetry. Interpretation Our pilot quantitative MRI study of hemispheric volumes suggests that premature patients might be at risk of altered expected left‐greater‐than‐right forebrain asymmetry following repair of LGEA. Future neurobehavioral studies in infants born with LGEA are needed to elucidate the functional significance of presented anatomical findings.

Impact of Infant Thoracic Non-cardiac Perioperative Critical Care on Homotopic-Like Corpus Callosum and Forebrain Sub-regional Volumes

“…Specifically, CSF partial volume estimate was (a) thresholded at 99% (eliminating voxels with <99% of their volume comprising CSF), (b) converted to a binary mask, and (c) subtracted from a mask of the whole brain outline in order to generate mask of total brain volume excluding the ventricular system, which underwent additional (d) minor manual editing to draw-in any missing brain tissue, resulting in a finalized total brain mask ( Figure 2B ). T1-weighted data analysis of total brain volumes in infant with LGEA has been previously published ( 43 ) while total brain volume masks served for total and sub-regional forebrain segmentation in this study. Total forebrain tissue mask was created by simply erasing the cerebellum and brainstem (medulla, pons and midbrain) from a total brain mask ( Figure 2B,C ).…”