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Prediction of short- and long-term outcomes using pre-operative ventricular size in infants with post-hemorrhagic ventricular dilation

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Abstract

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.

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Data availability

No datasets were generated or analyzed during the current study.

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Acknowledgements

We would like to thank the Department of Pediatrics, Medical College of Wisconsin (MCW), and the MCW Medical Student Summer Research Program (MSSRP) for supporting this research.

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Authors and Affiliations

  1. Medical College of Wisconsin, Milwaukee, WI, USA

    Molly Serebin

  2. Division of Quantitative Health Science, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    Jian Zhang & Ke Yan

  3. Division of Neonatology, Department of Pediatrics, Children’s Corporate Center, Medical College of Wisconsin, 999 N. 92 Street, Suite C410, Milwaukee, WI, 53226, USA

    Erwin Cabacungan & Susan Cohen

  4. Division of Pediatric Neuroradiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA

    Tejaswini Deshmukh & Mohit Maheshwari

  5. Division of Pediatric Neurosurgery, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Andrew Foy

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  1. Molly Serebin
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Contributions

MS, EC, AF, and SC wrote the main manuscript text; JZ and KY performed the statistical analysis; TD and MM performed all neuroradiologic assessments: and all authors reviewed the manuscript.

Corresponding author

Correspondence to Susan Cohen.

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Serebin, M., Zhang, J., Yan, K. et al. Prediction of short- and long-term outcomes using pre-operative ventricular size in infants with post-hemorrhagic ventricular dilation. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06371-2

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