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Open AccessArticle

Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

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Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
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Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
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Department of Radiology, Division of Neuroradiology, Boston Children’s Hospital, and Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
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Department of Pediatrics, Division of Neonatal Medicine, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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Department of Surgery, Boston Children’s Hospital, and Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
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Esophageal and Airway Treatment Center, Boston Children’s Hospital, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(12), 383; https://doi.org/10.3390/brainsci9120383
Received: 21 November 2019 / Revised: 11 December 2019 / Accepted: 14 December 2019 / Published: 17 December 2019
(This article belongs to the Special Issue The Effects of Early Drug Exposure on Brain Development)
We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA. View Full-Text
Keywords: infant; LGEA; midazolam; morphine; MRI; neuroimaging; opioids; term; tolerance; weaning infant; LGEA; midazolam; morphine; MRI; neuroimaging; opioids; term; tolerance; weaning
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Rudisill, S.S.; Wang, J.T.; Jaimes, C.; Mongerson, C.R.L.; Hansen, A.R.; Jennings, R.W.; Bajic, D. Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study. Brain Sci. 2019, 9, 383.

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