535 - Congenital Infectious Encephalopathies – Fetal MRI and Postnatal Outcomes

Poster Number: 535
Publication Number: 535.139

Natalie A. House, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Elizabeth A. Corn, Children's National Health System, DC, DC, United States; Roberta L. DeBiasi, Children's National Hospital and The George Washington University School of Medicine, Washington, DC, United States; Adre du Plessis, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Sarah B. Mulkey, Children's National Hospital, Washington, DC, United States

Background: Congenital infections cause a spectrum of fetal neurologic injury and morbidity in offspring. Fetal magnetic resonance imaging (feMRI) provides a more thorough evaluation of the fetal brain, however has not been routinely used in prenatal congenital infection care.

Objective: To describe feMRI findings in the evaluation of fetal congenital infections and corresponding postnatal outcomes.

Design/Methods: We performed a retrospective study of medical records from 1/1/12 to 5/1/21 of pregnant women referred to the Prenatal Pediatrics Institute at Children’s National Hospital, Washington, DC for suspected or confirmed congenital infections. Prenatal and postnatal diagnostic evaluations, including MRI, and multidisciplinary evaluation by fetal neurology and infectious disease along with postnatal outcomes were collected. Cases of Cytomegalovirus (CMV), Toxoplasma gondii (Toxo), and Parvovirus B19 (B19V) were included. Women without infections, with other infections (i.e. Zika virus), or unidentified likely infectious etiologies were excluded. Child medical charts were reviewed to assess outcome.

Results: 19 pregnant women-fetal/infant dyads with CMV (n=14), Toxo (n=4), and B19V (n=1) were included. 4 of 14 (29%) pregnancies with suspected or confirmed CMV were terminated; all had severe fetal brain injury by feMRI (microcephaly, hemorrhage, neuronal migration anomalies) and extracranial abnormalities. 10 of 14 (71%) pregnancies with CMV were live born; 4 were diagnosed with congenital CMV. Two infants were symptomatic with hearing loss, both had abnormal brain MRI: hypogenesis of the corpus callosum in one, polymicrogyria and intraventricular cyst in the other. The other cases had normal imaging and outcomes. 2 of 4 cases of suspected or confirmed Toxo had feMRI abnormalities of borderline microcephaly and mild bilateral ventriculomegaly. On postnatal brain MRI, the case with mild ventriculomegaly had sequelae of prior germinal matrix hemorrhage and hippocampal underrotation. One infant requires physical therapy, normal outcome in two, and one unknown after birth. The case of confirmed B19V had cerebellar infarction by feMRI and confirmed by postnatal brain MRI. Other than surgery for intermittent esotropia, the infant was asymptomatic.Conclusion(s): The use of feMRI enhances neurologic diagnosis and guides discussion of prognosis for women with confirmed or suspected congenital infections. Our findings provide some reassurance that infants with normal to mild brain abnormalities by fetal and postnatal MRI following in utero exposure to CMV, Toxo, and B19V can have positive outcomes.
Natalie House ResumeNHouse Resume.pdf