Presented at the Neonatal Society 2012 Spring Meeting.
Eckersley S, Vollmer B
University of Southampton School of Medicine
Background: To examine relationships between fetal Magnetic Resonance Imaging (MRI) diagnosis and subsequent neurodevelopmental outcome of surviving infants. In addition, to explore parental views on the care and advice they were given when referred for fetal MRI. Fetal MRI can be used to recognise and diagnose many fetal brain abnormalities in detail. However there is a scarcity of data with respect to how these MRI findings relate to the long term outcomes.
Methods: We identified all fetal brain MRIs undertaken at Southampton University Hospital (covering the whole Wessex area), during the period 07/2005-05/2010. Findings on fetal MRI were divided into five categories; isolated ventriculomegaly (VM), isolated agenesis of the Corpus Callosum (ACC), isolated posterior fossa abnormalities (PA), “miscellaneous” (i.e. more than one abnormality or an abnormality other than VM, ACC, PFA), and those where nothing abnormal was detected on MRI. From the total sample of 75, parents of all surviving infants (n=45) were contacted and the child’s neurodevelopmental outcome was assessed with the Ages and Stages Questionnaire (ASQ) 3rd edition. An in-house developed parental questionnaire was used to explore the parents’ perceptions of the care they received when undergoing fetal MRI.
Results: Of the 75 participants, isolated VM was seen in 31% (n=23), ACC in 15% (n=11), PA in 6% (n=5), and mixed or other abnormalities were found in 29% (n=22). Nothing abnormal was detected in 19% (n=14) of the scans. Of the 75 cases there were 45 surviving infants and a total of 44 parents of surviving infants were contacted. The response rate was low, 43% despite some parents having been sent three reminders. Pregnancy was terminated in 16/75 cases. With regards to survival, in the remaining 59 cases, isolated ACC was associated with the poorest outcome. Isolated PFA was associated with the most favourable outcome with no intra-uterine fetal or neonatal deaths in this group. Despite small numbers, the data available to date suggest no strong correlation between the degree of abnormality and outcome. From the completed parental questionnaires (n=15) we were able to determine that the majority of parents (66%) were more than satisfied and only 13% were unhappy with the overall care and advice they received.
Conclusion: By determining the relationships between fetal MRI diagnosis and subsequent neurodevelopmental outcome we should help strengthen the evidence-based advice that is needed following fetal MRI diagnosis. Clearer pathways for counselling future parents will lead to improvement of care. However, the poor response rate in this study suggests that cross sectional postal surveys in this group of patients may not be the optimal way to obtain reliable outcome data. This might be improved by enrolling the families at time of fetal MRI into a prospective comprehensive follow-up programme.
Corresponding author: sle106@soton.ac.uk