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Prediction of short- and long-term outcomes using pre-operative ventricular size in infants with post-hemorrhagic
Molly Serebin1, Jian Zhang2, Ke Yan2
1Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
A fronto-temporal horn ratio (FTHR) of ≥0.67 in premature infants with post-hemorrhagic ventricular dilation (PHVD) predicts developmental delays and worse outcomes, aiding intervention timing.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
- Developmental pediatrics
Background:
- Post-hemorrhagic ventricular dilation (PHVD) is a complication of intraventricular hemorrhage (IVH) in premature infants, often leading to developmental delays.
- The optimal timing for neurosurgical intervention in PHVD remains unclear, impacting long-term infant outcomes.
- Neuroimaging, specifically the fronto-temporal horn ratio (FTHR), offers a standardized method to assess ventricular dilation and guide treatment decisions.
Purpose of the Study:
- To establish a pre-operative fronto-temporal horn ratio (FTHR) threshold for predicting short- and long-term outcomes in premature infants with PHVD.
- To evaluate the accuracy of FTHR in predicting developmental delay in this vulnerable population.
- To correlate FTHR measurements with in-hospital and developmental assessments.
Main Methods:
- Retrospective cohort study of premature infants with severe IVH and PHVD requiring neurosurgical intervention.
- Analysis of pre-operative FTHR measurements using receiver operating characteristic (ROC) curves and area under the curve (AUC) to predict developmental delay.
- Review of in-hospital outcomes and developmental assessments for 43 infants treated between 2012 and 2019.
Main Results:
- FTHR measurements demonstrated excellent predictive accuracy for cognitive (AUC 0.89) and motor (AUC 0.88) delays.
- An average pre-operative FTHR ≥ 0.67 was significantly associated with poorer lung and feeding outcomes.
- High inter-observer reliability was observed for FTHR component measurements, ensuring consistency.
Conclusions:
- A pre-operative FTHR threshold of ≥ 0.67 can effectively identify premature infants with PHVD at higher risk for adverse developmental and clinical outcomes.
- This standardized imaging marker aids in optimizing the timing of neurosurgical interventions for PHVD.
- Further research into precise intervention thresholds can improve neurodevelopmental outcomes in affected infants.
Purpose:
Post-hemorrhagic ventricular dilation (PHVD) leads to developmental delays in premature infants, yet the optimal timing of neurosurgical interventions is unknown. Neuroimaging modalities have emerged to delineate injury and follow the progression of PHVD. Fronto-temporal horn ratio (FTHR) is used as a marker of ventricular dilation and can be a standardized tool to direct the timing of neurosurgical intervention. Our study determined a pre-operative FTHR measurement threshold to predict short- and long-term outcomes.
Methods:
This is a retrospective cohort study of premature infants with severe intraventricular hemorrhage (IVH) who developed PHVD requiring neurosurgical intervention and were treated in a level IV NICU between 2012 and 2019. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were performed to evaluate the accuracy of pre-operative FTHR for predicting developmental delay. In-hospital outcomes and developmental assessments were analyzed.
Results:
We reviewed 121 charts of infants with IVH and identified 43 infants with PHVD who required neurosurgical intervention. We found FTHR measurements were an excellent predictor of cognitive and motor delay with an AUC of 0.89 and 0.88, respectively. An average pre-operative FTHR of ≥ 0.67 was also associated with worse lung and feeding outcomes. There was excellent inter-observer reliability of individual components of FTHR measurements.
Conclusions:
Early intervention for PHVD is ideal but not always practical. Identification of ventricular size thresholds associated with better outcomes is needed to direct timing of neurosurgical intervention.
