Longitudinal Reference Values for Cerebral Ventricular Size in Preterm Infants Born at 23-27 Weeks of Gestation

Katharina Goeral,Hannah Schwarz,Marlene Hammerl,Jonas Brugger,Michael Wagner,Katrin Klebermass-Schrehof,Gregor Kasprian,Ursula Kiechl-Kohlendorfer,Angelika Berger,Monika Olischar

doi:10.1016/j.jpeds.2021.06.065

Katharina Goeral, Hannah Schwarz + Show 8 more

Open Access

https://doi.org/10.1016/j.jpeds.2021.06.065

Copy DOI

Abstract

To establish longitudinal reference values for cerebral ventricular size in the most vulnerable patients at risk for intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD). This retrospective study included neurologically healthy preterm neonates born at 230/7-266/7weeks of gestational age between September 2011 and April 2019. Patients were treated at 2 Austrian tertiary centers, Medical University of Vienna and Medical University of Innsbruck. All available cerebral ultrasound scans until 30weeks corrected age were analyzed. Ventricular measurements included ventricular index, anterior horn width (AHW), and thalamo-occipital distance (TOD) and longitudinal percentiles were created. The study cohort consisted of 244 preterm neonates, with a median gestational age of 253/7weeks (IQR, 244/7-260/7weeks) and a median birth weight of 735g (IQR, 644-849g). A total of 993 ultrasound scans were available for analysis, resulting in >1800 measurements of ventricular index, AHW, and TOD. Special attention was given to the 97th percentile as well as 2mm and 4mm above the 97th percentile, which are used internationally as cutoffs for intervention in the presence of PHVD. We present percentile charts based on a cohort of extremely premature infants including neonates born at the border of viability suited to follow-up the most vulnerable patients at risk for IVH and PHVD. Furthermore, we provide an extensive literature research and comparison of all available reference values, focusing on ventricular index, AHW, and TOD.

Highlights

Special attention was given to the 97th percentile as well as the 97th percentile + 2 mm and + 4 mm, cutoffs used internationally for making treatment decisions in the presence of posthemorrhagic ventricular dilatation (PHVD)
Some recordings had to be excluded owing to poor quality or incomplete datasets, resulting in 1913 ventricular index measurements, 1883 anterior horn width (AHW) measurements, and 1834 thalamo-occipital distance (TOD) measurements
Cerebral ultrasound–based ventricular reference curves allow clinicians to chart data of serial measurements and visualize changes in ventricular size over time in individual patients. This is especially important in extremely premature infants with progressive pressure-driven PHVD secondary to intraventricular hemorrhage (IVH)

Summary

Methods

This retrospective study included preterm infants born at 230/7-266/7 weeks of gestation between September 2011 and April 2019. Patients were treated at either the Medical University of Vienna or the Medical University of Innsbruck, Austria, both of which specialize in the care of preterm infants from 23 weeks gestation onward. We excluded all patients with IVH, perinatal asphyxia, cystic periventricular leukomalacia, major congenital and chromosomal anomalies (including complex congenital heart disease), metabolic disorders, cerebral malformations, and central nervous system infections. Excluded were neonates with weight or head circumference percentile below the 10th and above the 90th percentile at birth and those who died before the first cranial ultrasound scan was performed. The Institutional Review Board of the Medical University of Vienna (EK 1968/2017) approved this study

Results

Discussion

Conclusion