WIP 61 - Neuroimaging abnormalities and associated neurodevelopmental outcomes in infants with congenital kidney failure

Publication Number: WIP 61.7664

Melissa S.. Zhou, Stanford University School of Medicine, Palo Alto, CA, United States; Valerie Y.. Chock, Stanford University School of Medicine, Sunnyvale, CA, United States; Shina Menon, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Infants with congenital kidney failure [CKF, kidney replacement therapy (KRT) initiated in the neonatal period] are at high risk for neurologic morbidity and neurodevelopmental delay for reasons related to their prematurity, chronic kidney disease (e.g. uremia, malnultrition, toxic metabolites) and KRT (e.g. hemodynamic instability, use of heparin anticoagulation). The population of infants with CKF is growing with the increasing adoption of fetal interventions for olighydramnios/anhydramnios, and infant specific KRT modalities. The neurodevelopmental outcomes of a contemporary cohort of CKF are not well characterized.

Objective: Our aim was to describe neuroimaging abnormalities in infants with CKF and evaluate their association with neurodevelopmental outcomes.

Design/Methods: Single-center retrospective observational cohort study of 23 infants with CKF born 2018-2024. Neuroimaging studies included head ultrasound in 22 (96%) infants, brain magnetic resonance imaging (MRI) in 15 (65%) infants, and head computed tomography (CT) in 9 (39%) infants. Abnormal neuroimaging findings were categorized as stroke, intraventricular hemorrhage or subdural hemorrhage. Stroke was defined as parenchymal infarct and/or hemorrhage identified on MRI or CT imaging. Demographic characteristics and clinical outcomes for the entire cohort and by abnormal neuroimaging category were summarized. The chronological sequence of neuroimaging studies and corresponding abnormal findings for infants with stroke will be presented. The primary outcome is a composite of (1) mortality by 12 months adjusted age or (2) neurodevelopmental impairment (NDI). NDI is defined as meeting at least one of the following criteria at 12-16 months adjusted age: moderate to severe neurodevelopmental delay on pre-specified developmental assessments, Functional Status Scale (FSS) score of 18-30, severe visual or hearing impairment. These outcomes are currently being abstracted. Preliminary data analysis will be completed by March 2025. This study is IRB-approved (protocol #75739).