Abstract
For infants with acute progressive hydrocephalus, invasive drainage of cerebrospinal fluid (CSF) is performed until a ventriculo-peritoneal shunt can be inserted. Surrogate markers of intracranial pressure (ICP) may help optimise the timing of invasive procedures. To assess whether RI with/without fontanel compression helps distinguish between infants with normal (<5 cmH2O), mild (5–11 cmH2O), and moderate (>11 cmH2O) ICP elevation, 74 ICP measures before/after CSF removal and 148 related Doppler measures of the middle cerebral artery were assessed. Higher RI was associated with fontanel compression, elevated ICP, and their interaction (all p < 0.001). Without compression, differences in RI were observed between normal and moderate (p < 0.001) and between mild and moderate ICP elevation (p = 0.033). With compression, differences in RI were observed for all pairwise comparisons among normal, mild, and moderate ICP elevation (all p < 0.001). Without compression, areas under the receiver-operating characteristic curve for prediction of mild and moderate ICP elevation were 0.664 (95% confidence interval (CI), 0.538–0.791; p = 0.020) and 0.727 (95% CI, 0.582–0.872; p = 0.004), respectively, which improved to 0.806 (95% CI, 0.703–0.910; p < 0.001) and 0.814 (95% CI, 0.707–0.921; p < 0.001), respectively, with compression. RI with fontanel compression provides improved discrimination of infants with absent, mild, and moderate ICP elevation.
Highlights
Ventricular dilation is a common but serious complication of ventricular haemorrhage in preterm infants[1,2]
The resistance index (RI) obtained during fontanel compression better reflected invasively measured ICP17,18. This technique needs further validation, because of the relatively small number of intracranial pressure (ICP) measures used for the analysis (25 measures obtained from 12 infants before and after cerebrospinal fluid (CSF) removal)
All the infants were refractory to pharmacological treatment, and CSF drainage was started because of acute-progressive ventricular dilation (>2 cm/week; 4 infants), seizures (1 infant), or bradycardia (1 infant)
Summary
Ventricular dilation is a common but serious complication of ventricular haemorrhage in preterm infants[1,2]. For hydrocephalus refractory to pharmacological treatments, surgical drainage of the cerebrospinal fluid (CSF) is necessary[9], many premature infants are too small for placement of permanent drainage devices. In such cases, transient CSF removal is repeated until the time at which surgical intervention can be safely performed[10]. The resistance index (RI) obtained during fontanel compression better reflected invasively measured ICP17,18 Promising, this technique needs further validation, because of the relatively small number of ICP measures used for the analysis (25 measures obtained from 12 infants before and after CSF removal).
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