Quantitative MRI study of infant regional brain size following surgery for long‐gap esophageal atresia requiring prolonged critical care

Mongerson, Chandler R. L.; Jennings, Russell W.; Zurakowski, David; Bajic, Dusica

doi:10.1016/j.ijdevneu.2019.09.005

Cited by 11 publications

(45 citation statements)

References 75 publications

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“…We also report decreased normalized CC volumes in both full-term and premature patients scanned after complex perioperative LGEA treatment. This interesting finding is in contrast to our recent T2-weighted MRI study report 10 , which showed global decrease of gross brain, forebrain, and deep gray matter (viz. thalamus and basal ganglia) volumes.…”

Section: Discussioncontrasting

confidence: 99%

“…Likewise, normalized CC surface areas (% intracranial space surface area; graph C) differed among the groups with significantly smaller normative CC surface area found only between full-term patients and controls (p = 0.004). (2020) 10:6408 | https://doi.org/10.1038/s41598-020-63212-3 www.nature.com/scientificreports www.nature.com/scientificreports/ possibly implicate subtle cortical neuronal and/or astrocytic vulnerability in the setting of LGEA treatment, not previously seen by analysis of gross forebrain structure as a whole 10 .…”

Section: Discussionmentioning

confidence: 96%

“…Study design and participants. This work builds on our previous work 6,10 approved by Boston Children's Hospital Institutional Review Board as a 'no more than minimal risk' study. Informed written parental consent was obtained prior to subject participation, in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.…”

Section: Methodsmentioning

confidence: 97%

“…MRi acquisition. Our MRI scanning protocol was previously described in detail 6,10 . All infants underwent a non-sedated research scan after completion of all perioperative treatment for Foker process using a 'feed and wrap' approach [27][28][29][30] .…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported that critically ill full-term and premature infants following LGEA repair had previously unrecognized clinically significant MRI findings, as well as quantitative increase of cerebrospinal fluid and globally decreased brain size 6,10 . In the same pilot cohort of full-term and premature patients, we also 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 .…”

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confidence: 99%

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Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

Sci Rep

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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 longgap 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 T1weighted 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.

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confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

Sci Rep

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

Kagan

Mongerson

Zurakowski

et al. 2021

Ann Clin Transl Neurol

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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.

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Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure

McMahon,

Evanovich,

Pier

et al. 2023

Birth Defects Research

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BackgroundThere is limited knowledge regarding the impact of perioperative critical care on frequency of neurological imaging findings following esophageal atresia (EA) repair.MethodsThis is a retrospective study of infants (n = 70) following EA repair at a single institution (2009–2020). Sex, gestational age at birth, type of surgical repair, underlying disease severity, and frequency of neurologic imaging findings were obtained. We quantified the length of postoperative pain/sedation treatment and anesthesia exposure in the first year of life. Data were presented as numerical sums and percentages, while associations were measured using Spearman's Rho.ResultsVertebral/spinal cord imaging was performed in all infants revealing abnormalities in 44% (31/70). Cranial/brain imaging findings were identified in 67% (22/33) of infants in the context of clinically indicated imaging (47%; 33/70). Long‐gap EA patients (n = 16) received 10 times longer postoperative pain/sedation treatment and twice the anesthesia exposure compared with short‐gap EA patients (n = 54). The frequency of neurologic imaging findings did not correlate with underlying disease severity scores, length of pain/sedation treatment, or cumulative anesthesia exposure. Lack of associations between clinical measures and imaging findings should be interpreted with caution given possible underestimation of cranial/brain findings.ConclusionsWe propose that all infants with EA undergo brain imaging in addition to routine spinal imaging given the high burden of abnormal brain/cranial findings in our cohort. Quantification of pain/sedation and anesthesia exposure in long‐gap EA patients could be used as indirect markers in future studies assessing the risk of neurological sequelae as evidenced by early abnormalities on brain imaging.

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Quantitative MRI study of infant regional brain size following surgery for long‐gap esophageal atresia requiring prolonged critical care

Cited by 11 publications

References 75 publications

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

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

Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure

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