Título:	Neuroimaging assessment of pediatric cerebral changes associated with SARS-CoV-2 infection during pregnancy
Autor(es):	Araujo Junior, David Alves de Motta, Felipe Fernandes, Geraldo Magela Castro, Maria Eduarda Canellas de Sasaki, Lizandra Moura Paravidine Luna, Licia Pacheco Rodrigues, Thalys Sampaio Kurizky, Patricia Shu Soares, Alexandre Anderson de Sousa Munhoz Nóbrega, Otávio de Tolêdo Espindola, Laila Salmen Zaconeta, Alberto Carlos Moreno Gomes, Ciro Martins Martins Filho, Olindo Assis Albuquerque, Cleandro Pires de Mota, Licia Maria Henrique da
Afiliação do autor:	University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences University of Melbourne, Austin Health, Department of Medicine University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States University of Melbourne, Austin Health, Department of Medicine University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences University of Brasilia, Medical Sciences University of Brasilia, Medical Sciences University of Brasilia, Medical Sciences University of Brasilia, Medical Sciences University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas) University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences University of Brasilia, Department of Medicine Hospital Universitario de Brasília University of Brasilia, Medical Sciences
Assunto:	SARS-CoV-2 Desenvolvimento embrionário Ultrassonografia craniana Gravidez
Data de publicação:	23-Mai-2023
Editora:	Frontiers
Referência:	ARAUJO JUNIOR, David Alves de et al. Neuroimaging assessment of pediatric cerebral changes associated with SARS-CoV-2 infection during pregnancy. Frontiers in Pediatrics, [S. l.], v. 11, 23 maio 2023. DOI: https://doi.org/10.3389/fped.2023.1194114. Disponível em: https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1194114/full. Acesso em: 16 jul. 2024.
Abstract:	Background: SARS-CoV-2 infection and perinatal neurologic outcomes are still not fully understood. However, there is recent evidence of white matter disease and impaired neurodevelopment in newborns following maternal SARS-CoV-2 infection. These appear to occur as a consequence of both direct viral effects and a systemic inflammatory response, with glial cell/myelin involvement and regional hypoxia/microvascular dysfunction. We sought to characterize the consequences of maternal and fetal inflammatory states in the central nervous system of newborns following maternal SARS-CoV-2 infection. Methods: We conducted a longitudinal prospective cohort study from June 2020 to December 2021, with follow-up of newborns born to mothers exposed or not exposed to SARS-CoV-2 infection during pregnancy. Brain analysis included data from cranial ultrasound scans (CUS) with grayscale, Doppler studies (color and spectral), and ultrasound-based brain elastography (shear-wave mode) in specific regions of interest (ROIs): deep white matter, superficial white matter, corpus callosum, basal ganglia, and cortical gray matter. Brain elastography was used to estimate brain parenchymal stiffness, which is an indirect quantifier of cerebral myelin tissue content. Results: A total of 219 single-pregnancy children were enrolled, including 201 born to mothers exposed to SARS-CoV-2 infection and 18 from unexposed controls. A neuroimaging evaluation was performed at 6 months of adjusted chronological age and revealed 18 grayscale and 21 Doppler abnormalities. Predominant findings were hyperechogenicity of deep brain white matter and basal ganglia (caudate nuclei/thalamus) and a reduction in the resistance and pulsatility indices of intracranial arterial flow. The anterior brain circulation (middle cerebral and pericallosal arteries) displayed a wider range of flow variation than the posterior circulation (basilar artery). Shear-wave US elastography analysis showed a reduction in stiffness values in the SARS-CoV-2 exposed group in all analyzed regions of interest, especially in the deep white matter elasticity coefficients (3.98 ± 0.62) compared to the control group (7.76 ± 0.77); p-value < 0.001. Conclusion: This study further characterizes pediatric structural encephalic changes associated with SARS-CoV-2 infection during pregnancy. The maternal infection has been shown to be related to cerebral deep white matter predominant involvement, with regional hyperechogenicity and reduction of elasticity coefficients, suggesting zonal impairment of myelin content. Morphologic findings may be subtle, and functional studies such as Doppler and elastography may be valuable tools to more accurately identify infants at risk of neurologic damage.
Unidade Acadêmica:	Faculdade de Medicina (FM)
Programa de pós-graduação:	Programa de Pós-Graduação em Ciências Médicas
Licença:	© 2023 Alves de Araujo Junior, Motta, Fernandes, Castro, Sasaki, Luna, Rodrigues, Kurizky, Soares, Nobrega, Espindola, Zaconeta, Gomes, Martins-Filho, Albuquerque and Mota. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI:	https://doi.org/10.3389/fped.2023.1194114
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