Prediction of Short- and Long-term Outcomes Using Pre-Operative Ventricular Size in Infants with Post- Hemorrhagic Ventricular Dilation

Abstract

Abstract Purpose Post-hemorrhagic ventricular dilation (PHVD) leads to developmental delays in premature infants, yet the optimal timing for 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 the 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) treated in a level IV NICU that developed PHVD and required neurosurgical intervention between 2012 and 2019. A receiver operating characteristic (ROC) curve was performed to evaluate the pre-operative FTHR predictability for developmental delay. An area under the curve (AUC) measured the accuracy of FTHR. 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 measure of cognitive and motor delay with an AUC of 0.89 and 0.88, respectively. An average pre-operative FTHR of ≥ 0.67 was 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. Identifying ventricular size thresholds associated with better outcomes are needed to direct neurosurgical intervention timing.