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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00315

Infant Brain Structural MRI Analysis in the Context of Thoracic Noncardiac Surgery and Critical Care

 Chandler R. Mongerson1,  Sophie L. Wilcox1,  Stacy M. Goins1, 2, Danielle B. Pier3, David Zurakowski1, Russell W. Jennings4, 5 and  Dusica Bajic1*
  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard University, United States
  • 2Middlebury College, United States
  • 3Department of Neurology, Massachusetts General Hospital, Harvard Medical School, United States
  • 4Esophageal and Airway Treatment Center, Boston Children's Hospital, United States
  • 5Department of Surgery, Boston Children's Hospital, United States

Objective: To determine brain magnetic resonance imaging (MRI) measures of cerebrospinal fluid (CSF) and whole brain volume of full-term and premature infants following surgical treatment for thoracic noncardiac congenital anomalies requiring critical care.
Methods: Full-term (n=13) and preterm (n=13) patients with long-gap esophageal atresia, and full-term naïve controls (n=19) < 1 year corrected age, underwent non-sedated brain MRI following completion of thoracic noncardiac surgery and critical care treatment. Qualitative MRI findings were reviewed and reported by a pediatric neuroradiologist and neurologist. Several linear brain metrics were measured using structural T1-weighted images, while T2-weighted images were required for segmentation of total CSF and whole brain tissue using the Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS) tool. Group differences in absolute (mm, cm3) and normalized (%) data were analyzed using a univariate general linear model with age at scan as a covariate. Mean normalized values were assessed using one-way ANOVA.
Results: Qualitative brain findings suggest brain atrophy in both full-term and preterm patients. Both linear and volumetric MRI analyses confirmed significantly greater total CSF and extra-axial space, and decreased whole brain size in both full-term and preterm patients compared to naïve controls. Although linear analysis suggests greater ventricular volumes in all patients, volumetric analysis showed that normalized ventricular volumes were higher only in premature patients compared to controls.
Discussion: Linear brain metrics paralleled volumetric MRI analysis of total CSF and extra-axial space, but not ventricular size. Full-term infants appear to demonstrate similar brain vulnerability in the context of life-saving thoracic noncardiac surgery requiring critical care as premature infants.

Keywords: brain atrophy, Cerebrospinal Fluid – CSF, Full-term baby, Full-term and preterm infants, Long-gap esophageal atresia, prematurity, mantis, volumetric analysis of MRI scans

Received: 16 Jan 2019; Accepted: 11 Jul 2019.

Edited by:

Alberto Spalice, Policlinico Umberto I, Italy

Reviewed by:

Andrea D. Praticò, University of Catania, Italy
Andre Palmini, Pontifical Catholic University of Rio Grande do Sul, Brazil  

Copyright: © 2019 Mongerson, Wilcox, Goins, Pier, Zurakowski, Jennings and Bajic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD, PhD. Dusica Bajic, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard University, Boston, 02115, United States,