Status: Funded - Open
Defining a new parameter for post-hemorrhagic ventricular dilation in premature infants
Rawad Obeid, MD
BACKGROUND: More than 80% of extremely premature newborns now survive, but they remain at high risk for severe intraventricular hemorrhage (IVH) followed by post hemorrhagic ventricular dilation (PHVD) that can result in cerebral palsy (CP) and other neurodevelopmental disorders. In recent decades, bedside cranial ultrasound imaging has allowed close monitoring of PHVD.
GAP: The point at which PHVD starts to damage surrounding white matter and to increase the risk of CP is not defined. This study aims to link the change in a cranial ultrasound quantitative measure of PHVD [The frontal and temporal horn ratio (FTHR)] to white matter injury seen on brain MRI in a large cohort of extremely preterm newborns.
HYPOTHESIS: Distinct FTHR trajectories in extremely premature infants with and without IVH will identify PHVD. Accelerated FTHR trajectories in infants with IVH will correlate with higher qualitative white matter injury scores on brain MRI and altered MRI Diffusion Tensor Imaging (DTI).
METHODS: This is a retrospective study of extremely premature newborns admitted to a tertiary care NICU who all had multiple cranial ultrasounds and term – equivalent MRI imaging in whom FTHR trajectories of newborns with and without IVH will be calculated and correlated with white matter injury on MRI.
IMPACT: This study will provide the basis of a future clinical trial to optimize intervention timing for PHVD to decrease the risk of white matter injury in this vulnerable population with the ultimate goal of decreasing the incidence of cerebral palsy and adverse neurodevelopmental outcomes in this high risk patient population.
Optional/Additional Comments: This project was developed under the auspices of the Board of Visitors Perinatal Neuroprotection Program, a new initiative at Children’s National Medical Center.