Relationship between fetal brain development and congenital diaphragmatic hernia

Abstract

Congenital diaphragmatic hernia (CDH) is a complex fetal anomaly primarily associated with pulmonary hypoplasia and persistent pulmonary hypertension, but emerging evidence suggests that associated neurodevelopmental impairment may begin antenatally. This review examines current literature demonstrating alterations in fetal brain development in CDH, including regional reductions in brain volume, disrupted cortical architecture, and altered cerebral perfusion identified through fetal Magnetic Resonance Imaging (MRI) and Ultrasound-Doppler studies. Animal models further implicate hypoxia, impaired vascularisation, and neuroinflammation as contributing factors. These findings support a multifactorial pathogenesis involving hemodynamic and inflammatory mechanisms. Understanding antenatal brain changes in CDH may inform future prognostication and assist in optimising antenatal and postnatal management.

Keywords: Congenital diaphragmatic hernia; Magnetic resonance imaging; Neurodevelopment; Ultrasound.