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Published on: February 2, 2015
Longitudinal Reference Values for Cerebral Ventricular Size in Preterm Infants Born at 23-27 Weeks of Gestation
Katharina Goeral1, Hannah Schwarz1, Marlene Hammerl2
1Division of Neonatology, Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Insights
This study establishes reference values for brain ventricle size in extremely premature infants, aiding in the early detection of intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD). These charts help monitor vulnerable newborns at risk for these serious conditions.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Developmental Neuroscience
Background:
- Intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD) are significant concerns in extremely premature infants.
- Accurate reference values for cerebral ventricular size are crucial for monitoring these vulnerable neonates.
- Existing reference data may not adequately cover the earliest gestations at the border of viability.
Purpose of the Study:
- To establish longitudinal reference values for cerebral ventricular size in preterm neonates at high risk for IVH and PHVD.
- To create percentile charts for key ventricular measurements (ventricular index, anterior horn width, thalamo-occipital distance).
- To provide a tool for improved follow-up of the most vulnerable infants.
Main Methods:
- Retrospective analysis of cerebral ultrasound scans from neurologically healthy preterm neonates (230/7-266/7 weeks gestational age).
- Inclusion of data from two Austrian tertiary centers (Medical University of Vienna and Medical University of Innsbruck).
- Analysis of serial scans until 30 weeks corrected age, measuring ventricular index, anterior horn width (AHW), and thalamo-occipital distance (TOD).
Main Results:
- The cohort comprised 244 preterm neonates with a median gestational age of 253/7 weeks.
- Over 1800 measurements from 993 ultrasound scans were analyzed.
- Percentiles, including the 97th percentile and thresholds for intervention (2mm and 4mm above), were established for ventricular measurements.
Conclusions:
- Longitudinal percentile charts for cerebral ventricular size were developed for extremely premature infants.
- These charts are valuable for monitoring neonates at risk for IVH and PHVD, including those born at the limit of viability.
- The study also includes a comprehensive literature review and comparison of existing reference values for ventricular index, AHW, and TOD.
Objective:
To establish longitudinal reference values for cerebral ventricular size in the most vulnerable patients at risk for intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD).
Study Design:
This retrospective study included neurologically healthy preterm neonates born at 230/7-266/7 weeks of gestational age between September 2011 and April 2019. Patients were treated at 2 Austrian tertiary centers, Medical University of Vienna and Medical University of Innsbruck. All available cerebral ultrasound scans until 30 weeks corrected age were analyzed. Ventricular measurements included ventricular index, anterior horn width (AHW), and thalamo-occipital distance (TOD) and longitudinal percentiles were created.
Results:
The study cohort consisted of 244 preterm neonates, with a median gestational age of 253/7 weeks (IQR, 244/7-260/7 weeks) and a median birth weight of 735 g (IQR, 644-849 g). A total of 993 ultrasound scans were available for analysis, resulting in >1800 measurements of ventricular index, AHW, and TOD. Special attention was given to the 97th percentile as well as 2 mm and 4 mm above the 97th percentile, which are used internationally as cutoffs for intervention in the presence of PHVD.
Conclusions:
We present percentile charts based on a cohort of extremely premature infants including neonates born at the border of viability suited to follow-up the most vulnerable patients at risk for IVH and PHVD. Furthermore, we provide an extensive literature research and comparison of all available reference values, focusing on ventricular index, AHW, and TOD.
