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Grace Y. Lai, Pascale Aouad, Raye-Ann O. DeRegnier, Maria L. V. Dizon , Susan Palasis and Sandi K. Lam Ventriculomegaly thresholds for prediction of symptomatic post-hemorrhagic ventricular dilatation in preterm infants. Nature. 2022 Jan 31

BACKGROUND: Benefits from early surgical intervention in preterm infants with intraventricular hemorrhage  (IVH) prior to symptomatic ventriculomegaly must be weighed against risks of surgery. We calculated  thresholds of common ventriculomegaly indices at a late-intervention institution to predict subsequent symptomatic ventriculomegaly requiring neurosurgery.

METHODS: We retrospectively reviewed neuroimaging and neurosurgical outcomes in preterm infants with  grade III/IV IVHbetwee n 2007 and 2020. Frontal-occipital horn ratio (FOHR), frontal-temporal horn ratio  (FTHR), anterior horn width (AHW), and ventricular index (VI) were measured. Area under the receiver  operating curve (AUC) for predicting intervention (initiated after progressive symptomatic ventriculomegaly)  was calculated for diagnostic scan, scans during weeks 1–4, and maximum measurement prior to intervention. Threshold values that optimized sensitivity and specificity were derived.

RESULTS:  A total of 1254 scans in 132 patients were measured. In all, 37 patients had a neurosurgical
intervention. All indices differed between those with and without intervention from the first diagnostic scan (p  < 0.001). AUC of maximum measurement was 97.1% (95% CI 94.6–99.7) for FOHR, 97.7% (95% CI 95.6–99.8) for FTHR, 96.6% (95% CI 93.9–99.4) for AHW, and 96.8% (95% CI 94.0–99.5) for VI. Calculated thresholds were FOHR 0.66, FTHR 0.62, AHW 15.5 mm, and VI 8.4mm> p97 (sensitivities >86.8%, specificities >90.1%).

CONCLUSION: Ventriculomegaly indices were greater for patients who developed progressive persistent ventriculomegaly from the first diagnostic scan and predicted neurosurgical intervention.

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