scholarly journals Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention

2021 ◽  
pp. 1-11
Author(s):  
Mounica Paturu ◽  
Regina L. Triplett ◽  
Siddhant Thukral ◽  
Dimitrios Alexopoulos ◽  
Christopher D. Smyser ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Mri ◽  
Neurodevelopmental Outcome ◽  
Optimal Time ◽  
Preterm Neonates ◽  
Third Ventriculostomy ◽  
Cranial Ultrasound ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Ventricle Size

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks’ gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson’s r = −0.403, p = 0.046) and improved cognitive (r = −0.554, p = 0.047), motor (r = −0.487, p = 0.048), and language (r = −0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = −0.483, p = 0.014) and improved cognitive (r = −0.711, p = 0.001), motor (r = −0.675, p = 0.003), and language (r = −0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.

scholarly journals Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Walufu Ivan Egesa ◽  
Simon Odoch ◽  
Richard Justin Odong ◽  
Gloria Nakalema ◽  
Daniel Asiimwe ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Very Low Birth Weight ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes ◽  
Germinal Matrix ◽  
Posthemorrhagic Hydrocephalus ◽  
Management Interventions ◽  
Incidence Risk

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.

scholarly journals Sequential Cranial Ultrasound and Cerebellar Diffusion Weighted Imaging Contribute to the Early Prognosis of Neurodevelopmental Outcome in Preterm Infants

PLoS ONE ◽  
2014 ◽  
Vol 9 (10) ◽  
pp. e109556 ◽  
Author(s):  
Margaretha J. Brouwer ◽  
Britt J. M. van Kooij ◽  
Ingrid C. van Haastert ◽  
Corine Koopman-Esseboom ◽  
Floris Groenendaal ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Diffusion Weighted Imaging ◽  
Neurodevelopmental Outcome ◽  
Cranial Ultrasound ◽  
Diffusion Weighted

scholarly journals Intraventricular Hemorrhage Clearance in Human Neonatal Cerebrospinal Fluid

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1712-1719 ◽  
Author(s):  
Kelly B. Mahaney ◽  
Chandana Buddhala ◽  
Mounica Paturu ◽  
Diego Morales ◽  
David D. Limbrick ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Intraventricular Hemorrhage ◽  
Total Bilirubin ◽  
Preterm Neonates ◽  
Low Grade ◽  
Cranial Ultrasound ◽  
High Grade ◽  
Posthemorrhagic Hydrocephalus ◽  
Fluid Blood

Background and Purpose— Preterm neonates with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus and poor neurological outcomes. Iron has been implicated in ventriculomegaly, hippocampal injury, and poor outcomes following IVH. We hypothesized that levels of cerebrospinal fluid blood breakdown products and endogenous iron clearance proteins in neonates with IVH differ from those of neonates with IVH who subsequently develop posthemorrhagic hydrocephalus. Methods— Premature neonates with an estimated gestational age at birth <30 weeks who underwent lumbar puncture for clinical evaluation an average of 2 weeks after birth were evaluated. Groups consisted of controls (n=16), low-grade IVH (grades I–II; n=4), high-grade IVH (grades III–IV; n=6), and posthemorrhagic hydrocephalus (n=9). Control subjects were preterm neonates born at <30 weeks’ gestation without brain abnormality or hemorrhage on cranial ultrasound, who underwent lumbar puncture for clinical purposes. Cerebrospinal fluid hemoglobin, total bilirubin, total iron, ferritin, ceruloplasmin, transferrin, haptoglobin, and hemopexin were quantified. Results— Cerebrospinal fluid hemoglobin levels were increased in posthemorrhagic hydrocephalus compared with high-grade IVH (9.45 versus 6.06 µg/mL, P <0.05) and cerebrospinal fluid ferritin levels were increased in posthemorrhagic hydrocephalus compared with controls (511.33 versus 67.08, P <0.01). No significant group differences existed for the other cerebrospinal fluid blood breakdown and iron-handling proteins tested. We observed positive correlations between ventricular enlargement (frontal occipital horn ratio) and ferritin (Pearson r =0.67), hemoglobin (Pearson r =0.68), and total bilirubin (Pearson r =0.69). Conclusions— Neonates with posthemorrhagic hydrocephalus had significantly higher levels of hemoglobin than those with high-grade IVH. Levels of blood breakdown products, hemoglobin, ferritin, and bilirubin correlated with ventricular size. There was no elevation of several iron-scavenging proteins in cerebrospinal fluid in neonates with posthemorrhagic hydrocpehalus, indicative of posthemorrhagic hydrocephalus as a disease state occurring when endogenous iron clearance mechanisms are overwhelmed.

scholarly journals Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus

2019 ◽  
Vol 24 (4) ◽  
pp. 461-468
Author(s):  
Albert M. Isaacs ◽  
Joshua S. Shimony ◽  
Diego M. Morales ◽  
Leandro Castaneyra-Ruiz ◽  
Alexis Hartman ◽  
...  
Keyword(s):  
Diffusion Mri ◽  
Short Pulse ◽  
Brain Mri ◽  
Mean Diffusivity ◽  
White Matter Injury ◽  
Control Group ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Diffusion Weighted Images ◽  
Pediatric Hydrocephalus

OBJECTIVETraditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures.METHODSFast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed.RESULTSOf 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10−3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point.CONCLUSIONSThe utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.

scholarly journals Cranial Ultrasound in Moderate and Late Preterm Neonates: A Prospective Observational Study

2021 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Om Krishna Pathak ◽  
Yengkhom Rameshwor Singh ◽  
Rahul Mugurkar ◽  
Pradeep Suryawanshi
Keyword(s):  
Observational Study ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Case Record ◽  
Mechanically Ventilated ◽  
Late Preterm Infants ◽  
Ultrasound Findings

Introduction: Preterm infants’ brain is vulnerable to ischemic and hemorrhagic injuries due to structural and molecular immaturities as well as associated co-morbidities, which is usually detected by bedside cranial ultrasound. Cranial ultrasound findings are common in preterm infants’ of < 32 weeks, so cranial ultrasound is routinely recommended in them but there is no such recommendation regarding moderate and late preterm infants. The objective of this study is to find the cranial ultrasound abnormalities in moderate and late preterm infants. Methods: This prospective observational study was conducted in a tertiary level neonatal care unit. Hundred moderate and late preterm neonates delivered or admitted within seventh day of life were included in the study. Cranial ultrasound scan was performed between third and seventh day of life and before discharge and ultrasound findings were noted. Data were collected in predesigned case record form and analysed using Fischer Exact test. Results: Out of 100 neonates, 47 (47%) were males and 53 (53%) females. There were 43 (43%) moderately preterm and 57 (57%) late preterm infants. Mean day of life for performing first and second cranial ultrasound was 4.17 (3 - 7) days and 13.24 (3 - 40) days respectively. Cranial abnormalities were noted in 26% neonates. Intra-ventricular haemorrhage grade 1 or 2 was the commonest abnormality noted. Choroid plexus cyst (4%), cerebral edema (3%), periventricular hyperechogenicity (3%) and hydrocephalus (1%) were the other abnormalities noted. Neonates having APGAR < 6 at one minute, mechanically ventilated and having co-morbidities had significantly higher incidence of abnormal findings. Conclusions: It is reasonable to perform screening cranial ultrasound in high risk moderate and late preterm infants having low APGAR score, mechanically ventilated and having co-morbidities.

Brain GRowth Evaluation Assessed with Transfontanellar (B-GREAT) ultrasound. Old and new bedside markers to estimate cerebral growth in preterm infants: a pilot study

2021 ◽  
Author(s):  
Roberta Arena ◽  
Francesca Gallini ◽  
Domenico Umberto De Rose ◽  
Francesca Conte ◽  
Luca Giraldi ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Preterm Infants ◽  
Gestational Age ◽  
Intraclass Correlation ◽  
Growth Curves ◽  
Brain Structures ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Brain Growth ◽  
Growth Evaluation

Objective: We aimed to investigate the feasibility of evaluating overall preterm brain growth using a gathered set of measurements of brain structures in standard cranial ultrasound planes. We called this method of assessment Brain GRowth Evaluation Assessed with Transfontanellar ultrasound (B-GREAT). Study design: In this prospective observational cohort study, cranial ultrasound was regularly performed (on day 1, 2, 3, 7 of life and then weekly until discharge and at term) in preterm infants born with a gestational age less than 32 weeks. We evaluated Corpus Callosum (CC) length, Corpus Callosum-Fastigium (CCF) length, Anterior Horn Width (AHW), Frontal White Matter (FWM) height, Total brain Surface (TBS), Deep Grey Matter (DGM) height, Hemisphere Height (HH), Transverse Cerebellar Diameter in the axial view (TCDax) and coronal view (TCDcor). Measurements obtained were used to develop growth charts for B-GREAT markers as a function of postmenstrual age. Reproducibility of B-GREAT markers was studied. Results: A total of 528 cranial ultrasounds was performed in 80 neonates (median birth gestational age: 28+5 weeks, interquartile range: 27+3 to 30+5). The intraclass correlation coefficients for intra-observer and inter-observer analyses showed substantial agreement for all B-GREAT markers. Growth curves for B-GREAT markers were developed. Conclusion: B-GREAT is a feasible and reproducible method for bedside monitoring of the growth of the main brain structures in preterm neonates.

Ventricular Dilation Following Periventricular-Intraventricular Hemorrhage: Outcome at Age 1 Year

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 158-162
Author(s):  
Walter C. Allan ◽  
Douglas A. Dransfield ◽  
Alison M. Tito
Keyword(s):  
Intraventricular Hemorrhage ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Expectant Management ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Neurodevelopmental Delay ◽  
Ventriculoperitoneal Shunting ◽  
Neurodevelopmental Abnormalities

Ventricular dilation following periventricular-intraventricular hemorrhage can be managed without ventriculoperitoneal shunting in most cases. Twenty-six patients who had periventricular-intraventricular hemorrhage with subsequent ventricular dilation were examined at 1 year of age for neurodevelopmental outcome and hydrocephalus. As previously reported, ventricular dilation may be divided into two groups: ventriculomegaly and posthemorrhagic hydrocephalus. Fourteen patients with ventriculomegaly were followed up with serial ultrasound observations only, and 12 patients with posthemorrhagic hydrocephalus had temporary drainage of ventricular fluid. Only three patients with posthemorrhagic hydrocephalus required ventriculoperitoneal shunting in the neonatal period. Neurodevelopmental abnormalities were found in eight infants who had posthemorrhagic hydrocephalus and two who had ventriculomegaly. Six of these infants had intraparenchymal injury demonstrated by ultrasound, five as a result of the original hemorrhage and 1 by infection. A single infant with posthemorrhagic hydrocephalus, discharged from the hospital with stable ventricular size, developed hydrocephalus and neurodevelopmental delay after the neonatal period. This reversed with ventriculopenitoneal shunting at 1 year of age. It is suggested that even in patients developing ventricular dilation following periventricular-intraventricular hemorrhage, it is the primary intraparenchymal injury that is responsible for subsequent morbidity. Thus, provided serial reevaluations are possible, an expectant management of ventricular dilation is justified.

scholarly journals Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage

2012 ◽  
Vol 9 (5) ◽  
pp. 473-481 ◽  
Author(s):  
Jay Riva-Cambrin ◽  
Chevis N. Shannon ◽  
Richard Holubkov ◽  
William E. Whitehead ◽  
Abhaya V. Kulkarni ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Practice Patterns ◽  
Clinical Findings ◽  
Research Network ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Center Effect ◽  
Csf Diversion ◽  
Ventricular Reservoir

Object There is little consensus regarding the indications for surgical CSF diversion (either with implanted temporizing devices [reservoir or subgaleal shunt] or shunt alone) in preterm infants with posthemorrhagic hydrocephalus. The authors determined clinical and neuroimaging factors associated with the use of surgical CSF diversion among neonates with intraventricular hemorrhage (IVH), and describe variations in practice patterns across 4 large pediatric centers. Methods The use of implanted temporizing devices and conversion to permanent shunts was examined in a consecutive sample of 110 neonates surgically treated for IVH related to prematurity from the 4 clinical centers of the Hydrocephalus Clinical Research Network (HCRN). Clinical, neuroimaging, and so-called processes of care factors were analyzed. Results Seventy-three (66%) of the patients underwent temporization procedures, including 50 ventricular reservoir and 23 subgaleal shunt placements. Center (p < 0.001), increasing ventricular size (p = 0.04), and bradycardia (p = 0.07) were associated with the use of an implanted temporizing device, whereas apnea, occipitofrontal circumference (OFC), and fontanel assessments were not. Implanted temporizing devices were converted to permanent shunts in 65 (89%) of the 73 neonates. Only a full fontanel (p < 0.001) and increased ventricular size (p = 0.002) were associated with conversion of the temporizing devices to permanent shunts, whereas center, OFCs, and clot characteristics were not. Conclusions Considerable center variability exists in neurosurgical approaches to temporization of IVH in prematurity within the HCRN; however, variation between centers is not seen with permanent shunting. Increasing ventricular size—rather than classic clinical findings such as increasing OFCs—represents the threshold for either temporization or shunting of CSF.

scholarly journals Longitudinal comparison of diffusion tensor imaging parameters and neuropsychological measures following endoscopic third ventriculostomy for hydrocephalus

2012 ◽  
Vol 9 (6) ◽  
pp. 630-635 ◽  
Author(s):  
Robert T. Buckley ◽  
Weihong Yuan ◽  
Francesco T. Mangano ◽  
Jannel M. Phillips ◽  
Stephanie Powell ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Endoscopic Third Ventriculostomy ◽  
Diffusion Tensor ◽  
Neuropsychological Testing ◽  
Neurodevelopmental Outcome ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Neuropsychological Measures ◽  
Longitudinal Comparison ◽  
Ventricle Size

The authors report the case of a 25-month-old boy who underwent endoscopic third ventriculostomy (ETV) for hydrocephalus resulting from aqueductal stenosis. The patient's recovery was monitored longitudinally and prospectively using MR diffusion tensor imaging (DTI) and formal neuropsychological testing. Despite minimal change in ventricle size, improvement in the DTI characteristics and neurodevelopmental trajectory was observed following ETV. These data support the use of DTI as a biomarker to assess therapeutic response in children undergoing surgical treatment for hydrocephalus. In the patient featured in this report, DTI appeared to provide more information regarding postoperative neurodevelopmental outcome than ventricle size alone.

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