1. UOG Journal Club: September 2014 Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis G. Pagani, B. Thilaganathan and F. Prefumo Volume 44, Issue 3, Date: September 2014, Pages 254-260 Journal Club slides prepared by Dr. Katherine Goetzinger (UOG Editor for Trainees)

2. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Mild fetal ventriculomegaly occurs in 0.7% of pregnancies and is diagnosed when the atrial width of the lateral cerebral ventricle measures between 10 and 15mm. This diagnosis is variably associated with chromosomal and structural malformations as well as fetal infection. Ventriculomegaly is defined as isolated if no ultrasound evidence of associated malformations or markers of aneuploidy are observed at the time of presentation. Even when isolated, mild ventriculomegaly has been linked to abnormal neurodevelopment; however, this association varies widely in the literature with estimates ranging from 0% to 40%.

3. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Objective To perform a systematic review and meta-analysis of the current literature to: 1) assess the prevalence of neurodevelopmental delay in cases of isolated mild ventriculomegaly 2) assess the false-negative rate of prenatal imaging for the diagnosis of associated abnormalities in patients referred for isolated mild ventriculomegaly

4. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Methodology Systematic Review & Meta-Analysis Search Strategy: MEDLINE, EMBASE, Scopus, Cochrane Library Inclusion Criteria: Observational studies evaluating neurodevelopmental delay in cases of isolated mild ventriculomegaly Exclusion Criteria: Fetal karyotype not available, bilateral ventriculomegaly reported as an exclusion criterion, associated abnormality (chromosomal or structural) observed before or after birth, non-English language publication

5. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Methodology Systematic Review & Meta-Analysis Outcomes: Incidence of neurodevelopmental delay False-negative rate of prenatal imaging: prevalence of new postnatal findings in the group of cases labeled as isolated prenatally Analysis: Forest plots: random effects models Between-study heterogeneity: Higgins I2 Publication bias: funnel plots and Begg and Mazumdars rank correlation test Rosenthals failsafe N test and cumulative meta-analysis

6. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Results Potentially appropriate studies identified from search (n=961) Citations retrieved for detailed evaluation of manuscript (n=57) Studies included in systematic review (n=20) Citations excluded based on title or abstract (n=904) Studies excluded (n=37) After exclusions, there were a total of 652 cases of mild isolated ventriculomegaly, of which 67 cases had neurodevelopmental delay

7. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Results Of 1213 fetuses with a prenatal diagnosis of isolated mild ventriculomegaly, 57 (4.7%) had an abnormal karyotype Of those with a normal karyotype, associated abnormalities were found in 387 (33.5%), of which 355 (91.7%) were diagnosed before birth Postnatal imaging (ultrasound or MRI) was performed in 531 (43.8%) cases and identified 34 additional associated malformations

8. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Results The false-negative rate of prenatal imaging in the detection of associated structural malformations was: 7.4% (95% CI 3.1-11.8%) I2 random = 60.1%

9. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Results The incidence of neurodevelopmental delay in the 652 isolated cases of ventriculomegaly was: 7.9% (95% CI, 4.7-11.1%) I2 random = 55.9%

10. Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis Pagani et al., UOG 2014 Results Significant publication bias was identified (p