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Published on: February 2, 2015
Cranial sonography in very-low-birth-weight infants: do all infants need to be screened?
D A Paul1, S A Pearlman, M S Finkelstein
1Department of Pediatrics, Christiana Care Health System, Newark, DE, USA.
Insights
Clinical screening criteria are insufficient for diagnosing intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) in infants. These criteria miss a significant number of affected very-low-birth-weight infants, necessitating alternative diagnostic approaches.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Imaging
Background:
- Intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) are serious conditions affecting very-low-birth-weight infants.
- Accurate and timely diagnosis is crucial for appropriate management and improved outcomes.
Purpose of the Study:
- To develop and evaluate clinical screening criteria for diagnosing IVH and cystic PVL in neonates.
- To assess the effectiveness of clinical criteria in identifying infants requiring cranial sonography.
Main Methods:
- A case-control study involving 505 very-low-birth-weight infants across two cohorts.
- Univariate and multivariate analyses were used to develop screening criteria from cohort 1 data.
- The developed criteria were validated using data from cohort 2.
Main Results:
- Screening criteria for IVH showed low sensitivity (51%) and positive predictive value (31%).
- Screening criteria for cystic PVL demonstrated very low sensitivity (22%) and positive predictive value (2%).
- The criteria failed to identify a substantial proportion of infants with these neurological conditions.
Conclusions:
- Clinical screening criteria alone are inadequate for reliably diagnosing IVH and cystic PVL in very-low-birth-weight infants.
- Relying solely on clinical criteria risks missing significant numbers of affected neonates.
- Further research into improved diagnostic methods for these conditions is warranted.
Abstract:
The objective of the study was to develop clinical screening criteria to diagnose infants with intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL). We performed a case-control investigation of two cohorts of very-low-birth-weight infants (n = 505, combined cohorts). Univariate and multivariate analyses were performed from data obtained in cohort 1 to develop screening criteria for IVH and cystic PVL. The screening criteria were then applied to cohort 2. The screening criteria for IVH had a sensitivity of only 51%, a specificity of 62%, a positive predictive value of 31%, and a negative predictive value of 79%. Screening criteria for cystic PVL had a sensitivity of only 22%, a specificity of 58% a positive predictive value of 2%, and a negative predictive value of 95%. These data suggest that using clinical criteria to determine which infants should receive screening cranial sonography for IVH and cystic PVL would miss a substantial number of infants with these conditions.
