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Ratios of head circumference to ventricular size vary over time and predict eventual need for CSF diversion in intraventricular hemorrhage of prematurity

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Abstract

Purpose

Intraventricular hemorrhage (IVH) of prematurity can lead to hydrocephalus, sometimes necessitating permanent cerebrospinal fluid (CSF) diversion. We sought to characterize the relationship between head circumference (HC) and ventricular size in IVH over time to evaluate the clinical utility of serial HC measurements as a metric in determining the need for CSF diversion.

Methods

We included preterm infants with IVH born between January 2000 and May 2020. Three measures of ventricular size were obtained: ventricular index (VI), Evan’s ratio (ER), and frontal occipital head ratio (FOHR). The Pearson correlations (r) between the initial (at birth) paired measurements of HC and ventricular size were reported. Multivariable longitudinal regression models were fit to examine the HC:ventricle size ratio, adjusting for the age of the infant, IVH grade (I/II vs. III/IV), need for CSF diversion, and sex.

Results

A total of 639 patients with an average gestational age of 27.5 weeks were included. IVH grade I/II and grade III/IV patients had a positive correlation between initial HC and VI (r = 0.47, p < 0.001 and r = 0.48, p < 0.001, respectively). In our longitudinal models, patients with a low-grade IVH (I/II) had an HC:VI ratio 0.52 higher than those with a high-grade IVH (p-value < 0.001). Patients with low-grade IVH had an HC:ER ratio 12.94 higher than those with high-grade IVH (p-value < 0.001). Patients with low-grade IVH had a HC:FOHR ratio 12.91 higher than those with high-grade IVH (p-value < 0.001). Infants who did not require CSF diversion had an HC:VI ratio 0.47 higher than those who eventually did (p < 0.001). Infants without CSF diversion had an HC:ER ratio 16.53 higher than those who received CSF diversion (p < 0.001). Infants without CSF diversion had an HC:FOHR ratio 15.45 higher than those who received CSF diversion (95% CI (11.34, 19.56), p < 0.001).

Conclusions

There is a significant difference in the ratio of HC:VI, HC:ER, and HC:FOHR size between patients with high-grade IVH and low-grade IVH. Likewise, there is a significant difference in HC:VI, HC:ER, and HC:FOHR between those who did and did not have CSF diversion. The routine assessments of both head circumference and ventricle size by ultrasound are important clinical tools in infants with IVH of prematurity.

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Funding

This publication was made possible (in part) by Grant Number TL1 TR002555 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), awarded to Vishal Venkatraman. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCATS or NIH.

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Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Vishal Venkatraman, Srijan Bhasin, Kylie Calderon & Sage L. Atkins

  2. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Stephen C. Harward, Herbert E. Fuchs & Eric M. Thompson

  3. Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA

    Beiyu Liu, Hui-Jie Lee & Shein-Chung Chow

  4. Department of Neurological Surgery, University of Chicago, 5841 S Maryland Ave, MC3026, Chicago, IL, 60637, USA

    Eric M. Thompson

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Contributions

VV, SCH, and SB collected patient data and wrote the main manuscript text. KC and SLA collected patient data and edited the main manuscript text. BL, BL, and SC conducted statistical analyses and prepared all Figures and Tables. HEF and EMT wrote and provided edits to the main manuscript text. EMT provided study supervision. All authors reviewed the final manuscript.

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Correspondence to Eric M. Thompson.

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Venkatraman, V., Harward, S.C., Bhasin, S. et al. Ratios of head circumference to ventricular size vary over time and predict eventual need for CSF diversion in intraventricular hemorrhage of prematurity. Childs Nerv Syst 40, 673–684 (2024). https://doi.org/10.1007/s00381-023-06176-9

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