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Screening of hydrocephalus in infants using either WHO or population-based head circumference reference charts
Marjo Karvonen1,2, Antti Saari1,2, Marja-Leena Lamidi1
1Department of Pediatrics, School of Medicine, University of Eastern Finland, Kuopio, Finland.
Insights
Population-based references combined with head circumference standard deviation score changes offer superior screening for infant hydrocephalus compared to WHO standards. Customizing WHO standards improves accuracy.
Area of Science:
- Pediatric medicine
- Medical screening
- Auxology
Background:
- Hydrocephalus screening in infants requires accurate reference standards.
- Existing World Health Organization (WHO) standards may not be universally applicable.
- Population-based (PB) references offer an alternative for growth monitoring.
Purpose of the Study:
- To compare the effectiveness of WHO and PB references for infant hydrocephalus screening.
- To evaluate a novel screening parameter: change in head circumference standard deviation score over time (ΔHC SDS).
Main Methods:
- Analysis of 341 longitudinal head circumference (HC) measurements from hydrocephalic infants and 120,181 from healthy infants.
- Calculation of z-scores and ΔHC SDS.
- Receiver operating characteristics (ROC) analysis and linear mixed models for performance comparison.
Main Results:
- Hydrocephalic infants showed higher mean HC SDS (WHO: 3.5, PB: 2.9) than healthy infants (WHO: 1.0, PB: 0).
- The PB reference with ΔHC SDS achieved the highest screening accuracy (AUC 0.89).
- WHO standard accuracy improved to comparable levels with population-specific cut-offs and combined parameters.
Conclusions:
- Auxological measurements alone are insufficient for hydrocephalus screening.
- WHO standards require population-specific validation and defined cut-offs before implementation.
- Population-based references demonstrate higher accuracy in infant hydrocephalus screening.
Aim:
The aim was to compare the performances of the World Health Organization (WHO) and population-based (PB) references in the screening for hydrocephalus in infants aged <2 years.
Methods:
We collected 341 longitudinal head circumference (HC) measurements of hydrocephalic infants and 120 181 measurements of 15 145 healthy infants from primary care. The measurements were converted into z-scores, and a new screening parameter, change in HC standard deviation score (SDS) over time (ΔHC SDS), was calculated. Comparisons were made using receiver operating characteristics analysis and linear mixed models.
Results:
The mean HC SDSWHO was 3.5 and the mean HC SDSPB was 2.9 in the hydrocephalic infants, and in healthy children, those numbers were 1.0 SDSWHO and 0 SDSPB , respectively. The best screening accuracy was obtained with the PB reference in combination with the ΔHC SDS parameter (AUC 0.89). The accuracy of the WHO standard could be improved to a similar level by customising the screening cut-offs of HC SDS according to the population and combining screening parameters.
Conclusions:
Auxology alone was not sufficient for the screening of hydrocephalus. The WHO standard should be validated in the population, and population-specific cut-offs for normality defined before its introduction.
