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Predicting neurodevelopmental outcomes in fetuses with isolated mild ventriculomegaly
  1. Paul David Griffiths1,
  2. Deborah Jarvis1,
  3. Daniel J Connolly2,
  4. Cara Mooney3,
  5. Nicholas Embleton4,
  6. Anthony Richard Hart5
  1. 1 Academic Unit of Radiology, The University of Sheffield, Sheffield, UK
  2. 2 Neuroradiology, Sheffield Childrens Hospital NHS Foundation Trust, Sheffield, UK
  3. 3 Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
  4. 4 Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  5. 5 Department of Paediatric and Perinatal Neurology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Ms Cara Mooney, Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield S1 4DA, UK; c.d.mooney{at}sheffield.ac.uk

Abstract

Background Fetal ventriculomegaly is the the most common intracranial abnormality detected antenatally. When ventriculomegaly is mild and the only, isolated, abnormality detected (isolated mild ventriculomegaly (IMVM)) the prognosis is generally considered to be good. We aim to determine if there are features on in utero MRI (iuMRI) that can identify fetuses with IMVM who have lower risks of abnormal neurodevelopment outcome.

Methods We studied cases recruited into the MRI to enhance the diagnosis of fetal developmental brain abnormalities in utero (MERIDIAN) study, specifically those with: confirmed IMVM, 3D volume imaging of the fetal brain and neurodevelopmental outcomes at 3 years. We explored the influence of sex of the fetus, laterality of the ventriculomegaly and intracranial compartmental volumes in relation to neurodevelopmental outcome.

Findings Forty-two fetuses met the criteria (33 male and 9 female). There was no obvious correlation between fetal sex and the risk of poor neurodevelopmental outcome. Unilateral IMVM was present in 23 fetuses and bilateral IMVM in 19 fetuses. All fetuses with unilateral IMVM had normal neurodevelopmental outcomes, while only 12/19 with bilateral IMVM had normal neurodevelopmental outcomes. There was no obvious correlation between measure of intracranial volumes and risk of abnormal developmental outcomes.

Interpretation The most important finding is the very high chance of a good neurodevelopmental outcome observed in fetuses with unilateral IMVM, which is a potentially important finding for antenatal counselling. There does not appear to be a link between the volume of the ventricular system or brain volume and the risk of poor neurodevelopmental outcome.

  • neurology
  • neonatology

Data availability statement

Data are available upon reasonable request. Requests for patient-level data and statistical code should be made to the corresponding author and will be considered by members of the original trial management group, including the chief investigator and members of CTRU, who will release data on a case-by-case basis. Data will be shared following the principles for sharing patient-level data as described by Smith et al (2015) . The data will not contain any direct identifiers; we will minimise indirect identifiers and remove free-text data, to minimise the risk of identification.

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Data availability statement

Data are available upon reasonable request. Requests for patient-level data and statistical code should be made to the corresponding author and will be considered by members of the original trial management group, including the chief investigator and members of CTRU, who will release data on a case-by-case basis. Data will be shared following the principles for sharing patient-level data as described by Smith et al (2015) . The data will not contain any direct identifiers; we will minimise indirect identifiers and remove free-text data, to minimise the risk of identification.

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Footnotes

  • Contributors PDG, CM, NE and ARH conceptualised and designed the work. All others were involved in the acquisition of data. PDG analysed the data. PDG, DJC, NE and ARH were involved in the interpretation of data for the work. PDG and CM drafted the work and DJ, DJC, NE and ARH revised it critically for important intellectual content. PDG is the guarantor.

  • Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number 09/06/01).

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment Programme, NIHR, National Health Service, or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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