Strong heart, fit brain. Cardiac impact on brain development in fetuses with congenital diaphragmatic hernia: a prospective cohort study.

Abstract

Purpose CDH fetuses may present with abnormal brain volume and cerebral fissures. Since cardiac function and size may also be altered, we hypothesized that abnormal cardiac function may contribute in their impaired brain development. The aim of this study is to evaluate if cardiac dimensions and function correlate with brain development in CDH fetuses. Materials and Methods All fetuses with left CDH who underwent ultrasound evaluation of cardiac function and brain development between 2018 and 2023 were included. We analyzed the correlation between cardiac size and function parameters with the parieto-occipital (POF) and Sylvian (SF) fissures and insular depth (ID) at two gestation periods (GP). Cardiac and brain anatomical measures were corrected for head circumference, cardiac function parameters were corrected for estimated fetal weight or GA. Correlations were analyzed using Pearson test, p value <0.05 was considered significant. Results 24 fetuses with left CDH were included. Between 20 and 24 weeks gestation, POF, SF, and ID were significantly correlated with aortic flow. Right ventricle E/A was significantly correlated with POF and SF, with a trend toward correlation with ID, approaching the threshold of significance. In this GP, ID was also significantly correlated to the Left ventricle area, E/A, and E', S' and A'. Most correlations were lost in next GP. Conclusions Between 20 and 24 weeks gestation, brain development of fetuses with CDH is significantly correlated with cardiac function. Most of these correlations were lost at 25-28 weeks' gestation. Further studies are needed to confirm our results and to evaluate if these findings have postnatal clinical significance.