Qualitative and Simple Quantitative MRI Measures of Infant Brain Size: Is Prematurity a Risk Factor in the Setting of Surgery and Critical Care with Prolonged Sedation? Poster 15

Infants born with congenital long-gap esophageal atresia (LGEA) undergo complex neonatal surgical repair requiring prolonged critical care involving postoperative sedation. Our understanding of such treatment on the developing... [ view full abstract ]

Infants born with congenital long-gap esophageal atresia (LGEA) undergo complex neonatal surgical repair requiring prolonged critical care involving postoperative sedation. Our understanding of such treatment on the developing brain is limited. We hypothesized that critically-ill infants would exhibit increased fluid-filled spaces and decreased brain diameters irrespective of gestational age at birth in comparison to naïve infants. Full-term (n=13), preterm (n=12) patients, and comparative healthy controls (n=14) < 1 year of age underwent non-sedated structural MRI using a 3T Siemens scanner, as per IRB approval at Boston Children’s Hospital. Structural T1-weighted images were manually reoriented using Freeview. Two blinded researchers measured 7 diameters and 2 surface areas on ITK-SNAP. Five additional calculated end-points were analyzed. Both absolute (mm or cm²) and normalized (%) volumes were checked for normality and group differences in mean volumes were assessed using one-way ANOVA. Correlations between volume and age were also assessed within each group. Qualitative MRI findings suggest changes in total brain and CSF volume in patients in comparison to controls. MRI brain metrics suggest significant increase in extra-axial space and ventricular volumes in patients (irrespective of gestational age) compared to controls. Deep gray matter surface area was significantly different among groups. Similar findings for cerebellar diameters and surface area were not present. Data implicate that full-term patients in the context of LGEA treatment are as vulnerable to changes in forebrain tissue and cerebrospinal fluid measures as premature infants. Presented findings warrant future volumetric studies of brain size and growth in critically ill infants.