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Published on: January 27, 2023
Post-hemorrhagic ventricular dilatation: inter-observer reliability of ventricular size measurements in extremely
Lara M Leijser1, James N Scott2, Smita Roychoudhury3
1Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada. lara.leijser@ucalgary.ca.
Insights
Anterior horn width (AHW) and ventricular index (VI) measurements are reliable for assessing post-hemorrhagic ventricular dilatation (PHVD) in preterm infants. AHW is the strongest predictor for surgical intervention, aiding early diagnosis and management.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
- Medical imaging
Background:
- Post-hemorrhagic ventricular dilatation (PHVD) is a complication in preterm infants following intraventricular hemorrhage (IVH).
- Cranial ultrasound (cUS) and ventricular size indices are used to assess PHVD, but their inter-observer reliability needs further investigation.
- Predicting the severity of PHVD and the need for intervention is crucial for optimal patient outcomes.
Purpose of the Study:
- To evaluate the inter-observer reliability of ventricular size indices measured by cranial ultrasound for predicting severe PHVD in preterm infants.
- To determine the predictive value of these indices for the need for surgical intervention.
Main Methods:
- Serial neonatal cranial ultrasounds were performed on 139 infants with IVH at three time points.
- Three observers with varying experience independently measured Ventricular Index (VI), Anterior Horn Width (AHW), and Fronto-Temporal Horn Ratio (FTHR).
- Inter-observer reliability (ICC) and predictive values (AUC) for surgical intervention were calculated.
Main Results:
- Inter-observer reliability varied from poor to excellent, with higher reliability for VI and AHW (ICC 0.49-0.84/0.51-0.81) compared to FTHR (0.41-0.82).
- Reliability was better between experienced observers (ICC 0.65-0.99) than with inexperienced ones (ICC 0.28-0.88), especially from the second week post-birth.
- Anterior Horn Width (AHW) showed a slightly higher predictive value for intervention (AUC 0.86-0.96) than VI and FTHR.
Conclusions:
- Anterior Horn Width (AHW) and Ventricular Index (VI) are highly reproducible by experienced clinicians for assessing PHVD.
- AHW, particularly from the second week of life, is the strongest predictor of PHVD severity and the need for surgical intervention.
- Consistent use of AHW and VI can improve early PHVD diagnosis, decision-making for intervention, and long-term outcomes in preterm infants.
Background:
Post-hemorrhagic ventricular dilatation (PHVD) in preterm infants can be assessed with ventricular size indices from cranial ultrasound. We explored inter-observer reliability of these indices for prediction of severe PHVD.
Methods:
For all 139 infants with IVH, serial neonatal ultrasound at 3 time points (days 4-7, day 14, 36 weeks PMA) were assessed independently by 3 observers with differing levels of training/experience. Ventricular index (VI), anterior horn width (AHW), and fronto-temporal horn ratio (FTHR) were measured and used to diagnose PHVD. For all, inter-observer reliability and predictive values for receipt of surgical intervention were calculated.
Results:
Inter-observer reliability for all observers varied from poor to excellent, with higher reliability for VI/AHW (ICC 0.49-0.84/0.51-0.81) than FTHR (0.41-0.82), particularly from the second week. Good-excellent inter-expertise reliability was found between observers with ample experience/training (0.65-0.99), particularly for VI and AHW, while poor-moderate when comparing with an inexperienced observer (0.28-0.88). Slightly higher predictive value for PHVD intervention (n = 12) was found for AHW (AUC 0.86-0.96) than for VI and FTHR (0.80-0.96/0.80-0.95).
Conclusions:
AHW and VI are highly reproducible in experienced hands compared to FTHR, with AHW from the second week onwards being the strongest predictor for receiving surgical intervention for severe PHVD. AHW may aid in early PHVD diagnosis and decision-making on intervention.
Impact:
While ventricular size indices from serial cUS are superior to clinical signs of increased intracranial pressure to assess PHVD, questions remained on their inter-observer reproducibility and reliability to predict severity of PHVD. AHW and VI are highly reproducible when performed by experienced clinicians. AHW from the second week of birth is the strongest predictor of PHVD onset and severity. AHW, combined with VI, may aid in early PHVD diagnosis and decision-making on need for surgical intervention. Consistent use of these indices has the potential to improve PHVD management and therewith the long-term outcomes in preterm infants.
