Supplementary Material for: Early magnetic resonance imaging predicts 12 month outcome in neonates with congenital diaphragmatic hernia

Introduction: Advances in neonatology, neonatal surgery, and extracorporeal membrane oxygenation (ECMO) have improved the prognosis of congenital diaphragmatic hernia (CDH). However, CDH survivors are at considerable risk of long-term neurological morbidity. Magnetic resonance imaging (MRI) abnormalities are reported in up to 84% of CDH-survivors but have only been rarely compared with neurodevelopmental outcomes. This study aims to investigate whether assessment of postnatal MRI in CDH-survivors allowed association with and prediction of long-term outcome. Methods: Brain MRI was performed in 36 neonates with CDH using the Weeke-score, assessing the mammillary bodies, the corpus callosum, cortical folding and cerebrospinal fluid space (CSF). Outcomes were measured using Bayley-III-examinations at 12 months. Results: 91.6% of the neonates exhibited MRI-abnormalities. Among them, 83.3% showed white matter (WM), 16.6% grey matter abnormalities, 8.3% cerebellar abnormalities, and 20% had an intracranial hemorrhage. 30.5% showed abnormal mammillary bodies, 44.4% enlarged CSF , 5.5% reduced cortical folding, and 8.3% reduced corpus callosum thickness. While the use of the Weeke-score was not helpful for outcome prediction, specific MRI abnormalities were associated with adverse long-term outcomes. Based on these findings, a novel MRI-scoring- system was developed. This easy-to-perform score effectively predicted adverse outcomes at 12 months. Conclusion Interpretation of MRI in neonates with CDH should focus on WM pathologies, CSF enlargement, internal capsule involvement, mammillary body abnormalities, and IVH. Our novel simple scoring system helps to identify neonates at risk for adverse neurological outcomes at discharge and aids to implement therapeutic strategies at an early point.