P463 Infant neurocognitive screening with cerebral MRI and app-based assessment of generalised movements is feasible following exposure to maternal inflammatory bowel disease in-utero
Authors: Prentice R , Hunt R , Spittle A , Ditchfield M , Chen J , Burns M , Wright E , Flanagan E , Ross A , Goldberg R , Bell S ,   Pregnancy in Crohn's and Colitis: Observations Levels and Outcomes Extension (PICCOLO-X)
Published: January 2024

Abstract

Background
Exposure to maternal inflammation in-utero is associated with an increased risk of neurocognitive developmental disorders in offspring, including cerebral palsy (CP). An increased risk of CP and neurological morbidity has been reported in infants of women with CD and UC in registry but not prospective cohort studies. Unsedated neonatal cerebral MRI (nMRI) allows for early assessment of brain microstructural integrity, with bipartietal diameter (BPD) predictive of cognitive and motor outcomes in preterm infants. Generalised movement assessments evaluate the character of infant’s spontaneous movements, can be undertaken remotely by parents with app-based technology (BabyMoves (BM) and are an early indicator of being high risk for cerebral palsy. nMRI & BM have not been used to screen for adverse neurocognitive outcomes in infants born to women with inflammatory disorders. We aimed to assess the feasibility of nMRI and BM in infants born to women with IBD and correlate abnormalities with maternal biochemical inflammation antenatally.

Methods
Pregnant women with IBD were assessed clinically and biochemically (faecal calprotectin (FC), CRP) in each trimester of pregnancy in this single centre prospective pilot study. Biochemically active disease was defined by FC &gt;100ug/g or CRP &gt;15mg/L. Infants underwent nMRI using a 1.5T MRI with T1-weighted and T2/proton density-weighted sequences performed at 6-12 weeks post-corrected term. Parents filmed 2 BM videos at 12-14 & 14-16 weeks post-corrected term. nMRIs (Figure 1) and BMs were scored by blinded reviewers with validated scoring systems. Metric nMRI data were corrected for gestational age (cGA). Descriptive statistics and spearman correlation coefficients were performed.

Results
40 mother-baby pairs, 19 with CD & 20 exposed to a biologic drug, were recruited. Most patients were in biochemical remission throughout pregnancy with median FC &lt;50ug/g and &lt;13% having a CRP &gt;15g/L in trimesters 1-3. At delivery 2/40 infants were premature, 4/40 low birth weight & 3/40 required neonatal intensive care. The median cGA at nMRI was 46 weeks 6 days (range 42 + 5-53 + 4). 2/39 MRI were of insufficient quality for scoring. 5/37 nMRI and 4/35 BM were abnormal, with 1/7 having a clinically significant adverse outcome (Table 1). Biparietal diameter did not correlate with maternal CRP or FC in any trimester of pregnancy.

Conclusion
nMRI & BM for infant neurocognitive disorder screening is feasible in the setting of maternal IBD. In this cohort of 40 infants, one clinically significant abnormality was identified in an infant of a mother with inactive IBD. Larger studies are required to stratify the risk of adverse neurocognitive outcomes in infants born to women with maternal inflammatory disorders.