Date of Award

Summer 2017

Document type

Thesis

Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Dr. Adrienne Foran

Second Supervisor

Professor Naomi McCallion

Funder/Sponsor

The Children's Fund for Health, Children's University Hospital - Temple Street.

Keywords

IUGR, Neuroimaging, Resting State fMRI, Neonatology

Abstract

Intra-uterine growth restriction (IUGR) is defined as a failure of a fetus to achieve its expected weight for a given gestational age. These infants have increased mortality and morbidity rates compared to appropriately grown infants. Deficits in cognition, language and social functions may occur. StOOPs (Short-term Outcome Of PORTO study) is a national study incorporating brain imaging to investigate differences in brain development and organisation between two groups of IUGR infants; those with normal and abnormal antenatal Doppler measurements. Antenatal Doppler examination of blood flow in the umbilical artery is used to monitor pregnancies affected with IUGR.

Singleton infants without aneuploidy or congenital anomaly and with an estimated fetal weight < 10th centile were enrolled nationally. Prospective data of delivery and infant characteristics was collected. Non-sedated 3 Tesla MRI of brain was acquired at term corrected gestation. 34 IUGR infants with abnormal umbilical arterial Doppler measurements, 29 IUGR infants with normal measurements and 11 healthy term controls were recruited. Connectivity analyses and voxel based morphometry analysis were performed. Growth and developmental assessments were performed at 1 year of age.

Resting state networks were identified. No group differences were found for the default mode network (DMN). Parts of the dorsal attention network (DAN), sensory networks and thalamic connections all showed systematic disturbance in the Abnormal Doppler group. Volumetric differences were identified between the three groups, which were correlated with one-year outcome measures. Communication scores positively correlate with volume in two cluster areas identified; a brainstem region and a region around the central gyrus. Personal & Social scores are negatively correlated with volume in a region in the right frontal lobe.

Differences between IUGR infant brains based on Doppler status are identifiable at term corrected age. These findings suggest that AbD group may benefit from early intensive interventions.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

30.9 MB

Comments

A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2017.

Available for download on Saturday, June 30, 2018

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