NICU Follow Up and Neurodevelopment 6: The NICU Stay and Outcomes
58 - Prediction of Developmental Outcome Using Pre-Operative Ventricular Size in Infants with Post-Hemorrhagic Ventricular Dilation
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 58 Publication Number: 58.446
Susan S. Cohen, Medical College of Wisconsin, Milwaukee, WI, United States; Molly Serebin, Medical College of Wisconsin, Wauwatosa, WI, United States; Jian Zhang, Medical College of Wisconsin, Milwaukee, WI, United States; Ke Yan, Medical College of Wisconsin, Milwaukee, WI, United States; Katherine A. Carlton, Medical College of Wisconsin, Mequon, WI, United States; Erwin T. Cabacungan, Medical College of Wisconsin, Wauwatosa, WI, United States; Andrew B. Foy, Medical College of Wisconsin, Milwaukee, WI, United States
Associate Professor Medical College of Wisconsin Milwaukee, Wisconsin, United States
Background: Post-hemorrhagic ventricular dilation (PHVD) can lead to developmental delays in premature infants, yet the optimal timing for interventions to prevent harm is unknown. Neuroimaging modalities have emerged to delineate injury and follow its progression. Frontotemporal horn ratio (FTHR) is used as a marker of ventricular dilation (FTHR > 0.55) and can become a standardized tool to direct the timing of neurosurgical intervention. Objective: To determine the pre-operative FTHR measurement threshold to predict the developmental outcome at 24 months of age. Design/Methods: This is a retrospective cohort study of premature infants with severe intraventricular hemorrhage (IVH) that developed PHVD and required neurosurgical intervention at our Level 4 neonatal ICU between January 2013 to December 2020. FTHR measurements were collected from head ultrasounds at two time points: day of life 7 and before neurosurgical intervention. Bayley Scales of Infant Development composite scores of cognitive and motor domains were collected at 24 months of age and developmental delay was set at a composite score of < 85 in any domain. An ROC curve (receiver operating characteristic curve) was performed to evaluate a threshold of pre-operative FTHR for predicting developmental delay. SAS 9.4 and IBM SPSS Statistics 28 were used for the analyses. Results: We reviewed 137 charts of patients with IVH and identified 36 infants with PHVD who required neurosurgical interventions and survived until developmental testing at 24 months of age. Among the 36 infants, 15 infants had cognitive testing and 14 had motor testing. We found FTHR measurements were an excellent predictor of cognitive and motor delay with an AUC (area under the curve) of 0.89 and 0.88, respectively. A pre-operative FTHR of ≥0.67 predicts cognitive delay with 78% sensitivity and 83% specificity and motor delay with 75% sensitivity and 83% specificity.
Conclusion(s): We have determined a sensitive and specific FTHR threshold for PHVD that predicts cognitive and motor delays in premature infants at 24 months of age. This standardized tool to measure ventricular dilation has the potential to prevent harm by directing clinical and neurosurgical intervention.
