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For: Whittemore BA, Swift DM, M Thomas J, F Chalak L. A neonatal neuroNICU collaborative approach to neuromonitoring of posthemorrhagic ventricular dilation in preterm infants. Pediatr Res 2022;91:27-34. [PMID: 33627823 DOI: 10.1038/s41390-021-01406-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/31/2023]

For:	Whittemore BA, Swift DM, M Thomas J, F Chalak L. A neonatal neuroNICU collaborative approach to neuromonitoring of posthemorrhagic ventricular dilation in preterm infants. Pediatr Res 2022;91:27-34. [PMID: 33627823 DOI: 10.1038/s41390-021-01406-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/31/2023]

Number

Cited by Other Article(s)

Kim CY, Kim SK. Editor's Pick in May 2023. J Korean Neurosurg Soc 2023;66:223-224. [PMID: 37170494 PMCID: PMC10183256 DOI: 10.3340/jkns.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open

Lai GY, Aouad P, DeRegnier RAO, Dizon MLV, Palasis S, Lam SK. Ventriculomegaly thresholds for prediction of symptomatic post-hemorrhagic ventricular dilatation in preterm infants. Pediatr Res 2022;92:1621-1629. [PMID: 35184137 DOI: 10.1038/s41390-022-01993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]

Abstract

BACKGROUND

Benefits from early surgical intervention in preterm infants with intraventricular hemorrhage (IVH) prior to symptomatic ventriculomegaly must be weighed against risks of surgery. We calculated thresholds of common ventriculomegaly indices at a late-intervention institution to predict subsequent symptomatic ventriculomegaly requiring neurosurgery.

METHODS

We retrospectively reviewed neuroimaging and neurosurgical outcomes in preterm infants with grade III/IV IVH between 2007 and 2020. Frontal-occipital horn ratio (FOHR), frontal-temporal horn ratio (FTHR), anterior horn width (AHW), and ventricular index (VI) were measured. Area under the receiver operating curve (AUC) for predicting intervention (initiated after progressive symptomatic ventriculomegaly) was calculated for diagnostic scan, scans during weeks 1-4, and maximum measurement prior to intervention. Threshold values that optimized sensitivity and specificity were derived.

RESULTS

A total of 1254 scans in 132 patients were measured. In all, 37 patients had a neurosurgical intervention. All indices differed between those with and without intervention from the first diagnostic scan (p < 0.001). AUC of maximum measurement was 97.1% (95% CI 94.6-99.7) for FOHR, 97.7% (95% CI 95.6-99.8) for FTHR, 96.6% (95% CI 93.9-99.4) for AHW, and 96.8% (95% CI 94.0-99.5) for VI. Calculated thresholds were FOHR 0.66, FTHR 0.62, AHW 15.5 mm, and VI 8.4 mm > p97 (sensitivities >86.8%, specificities >90.1%).

CONCLUSION

Ventriculomegaly indices were greater for patients who developed progressive persistent ventriculomegaly from the first diagnostic scan and predicted neurosurgical intervention.

IMPACT

We derived thresholds of common ventriculomegaly indices (ventricular index, anterior frontal horn width, fronto-occipital horn and fronto-temporal horn index) to best predict the development of progressive symptomatic post-hemorrhage hydrocephalus in preterm infants with intraventricular hemorrhage. While current thresholds were established by a priori expert consensus, we report the first data-driven derivation of ventriculomegaly thresholds across all indices for the prediction of symptomatic hydrocephalus. Data-derived thresholds will more precisely weigh the risks and benefits of early intervention.

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Degree of ventriculomegaly predicts school-aged functional outcomes in preterm infants with intraventricular hemorrhage. Pediatr Res 2022;91:1238-1247. [PMID: 34215837 DOI: 10.1038/s41390-021-01631-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 11/08/2022]

Abstract

BACKGROUND

Greater ventriculomegaly in preterm infants with intraventricular hemorrhage (IVH) has been associated with worse neurodevelopmental outcomes in infancy. We aim to explore the relationship between ventriculomegaly and school-age functional outcome.

METHODS

Retrospective review of preterm infants with Grade III/IV IVH from 2006 to 2020. Frontal-occipital horn ratio (FOHR) was measured on imaging throughout hospitalization and last available follow-up scan. Pediatric Cerebral Performance Category (PCPC) scale was used to assess functional outcome at ≥4 years. Ordinal logistic regression was used to determine the relationship between functional outcome and FOHR at the time of Neurosurgery consult, neurosurgical intervention, and last follow-up scan while adjusting for confounders.

RESULTS

One hundred and thirty-four infants had Grade III/IV IVH. FOHR at consult was 0.62 ± 0.12 and 0.75 ± 0.13 at first intervention (p < 0.001). On univariable analysis, maximum FOHR, FOHR at the last follow-up scan, and at Neurosurgery consult predicted worse functional outcome (p < 0.01). PVL, longer hospital admission, and gastrotomy/tracheostomy tube also predicted worse outcome (p < 0.05). PVL, maximum FOHR, and FOHR at consult remained significant on multivariable analysis (p < 0.05). Maximum FOHR of 0.61 is a fair predictor for moderate-severe impairment (AUC 75%, 95% CI: 62-87%).

CONCLUSIONS

Greater ventricular dilatation and PVL were independently associated with worse functional outcome in Grade III/IV IVH regardless of neurosurgical intervention.

IMPACT

Ventriculomegaly measured by frontal-occipital horn ratio (FOHR) and periventricular leukomalacia are independent correlates of school-age functional outcomes in preterm infants with intraventricular hemorrhage regardless of need for neurosurgical intervention. These findings extend the known association between ventriculomegaly and neurodevelopmental outcomes in infancy to functional outcomes at school age. FOHR is a fair predictor of school-age functional outcome, but there are likely other factors that influence functional status, which highlights the need for prospective studies to incorporate other clinical and demographic variables in predictive models.

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Vadset TA, Rajaram A, Hsiao CH, Kemigisha Katungi M, Magombe J, Seruwu M, Kaaya Nsubuga B, Vyas R, Tatz J, Playter K, Nalule E, Natukwatsa D, Wabukoma M, Neri Perez LE, Mulondo R, Queally JT, Fenster A, Kulkarni AV, Schiff SJ, Grant PE, Mbabazi Kabachelor E, Warf BC, Sutin JDB, Lin PY. Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC. Metabolites 2022;12:78. [PMID: 35050201 PMCID: PMC8781620 DOI: 10.3390/metabo12010078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 01/06/2023] Open

Affiliation(s)

Taylor A. Vadset Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
Ajay Rajaram Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
Chuan-Heng Hsiao Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
Miriah Kemigisha Katungi CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Joshua Magombe CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Marvin Seruwu CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Brian Kaaya Nsubuga CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Rutvi Vyas Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
Julia Tatz Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
Katharine Playter Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
Esther Nalule CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Davis Natukwatsa CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Moses Wabukoma CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Luis E. Neri Perez Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
Ronald Mulondo CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Jennifer T. Queally Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
Aaron Fenster Robarts Research Institute, Western University, London, ON N6A 3K7, Canada;
Abhaya V. Kulkarni The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
Steven J. Schiff Center for Neural Engineering, Center for Infectious Disease Dynamics, Departments of Engineering Science and Mechanics, Neurosurgery, and Physics, The Pennsylvania State University, University Park, PA 16802, USA;
Patricia Ellen Grant Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
Edith Mbabazi Kabachelor CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
Benjamin C. Warf Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
Jason D. B. Sutin Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
Pei-Yi Lin Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.) Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA

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Cohen S, Mietzsch U, Coghill C, Dereddy N, Ducis K, El Ters N, Heuer GG, Sewell E, Flibotte J. Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus. Am J Perinatol 2021;40:883-892. [PMID: 34293803 DOI: 10.1055/s-0041-1732417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]