Clinical application of 3D ultrasound in neonatal intraventricular hemorrhage
Abstract
Preterm neonates are at risk for intraventricular hemorrhage (IVH) and subsequent post-hemorrhagic hydrocephalus (PHH). A well-accepted interventional therapy for PHH is ventricular tap (VT). Permanent treatment, ventriculo peritoneal shunt surgery (VPS) is required in the case of some neonates under some conditions (weight, immunological status, CSF protein level) who receive multiple interventions. The objective of this study was to apply a 3D ultrasound system clinically to determine CSF volume within the ventricle, to guide the neurosurgeon regarding the amount of CSF should be removed during every intervention, which lateral ventricle is better to intervene and to predict the possibilities of the requirement of the shunt. After ethics approval and parental consent, this 3D US system was used in a clinical study where data of 70 neonates having IVH were analyzed retrospectively and 22 preterm neonates were recruited prospectively. 3D US system was used to measure the ventricle volume of the neonates. In addition, we have changed the posture of some neonates to find the volume variation in two lateral postures. We found that 3D US ventricle volume had a higher correlation (Pearson correlation 0.739) with the amount of CSF removed in each tap than other parameters (weight, age, head circumference). After changing the posture of the neonates, we did not find any significant volume change of two lateral ventricle volumes (P-value was 0.353 in case of the right ventricle in two different postures and 0.473 in case of the left ventricle in two different postures). We also found more volume change after VT in those patients who required VPS than who did not need a VPS (volume change was18.70 ± 10.98 cm3 in shunt treated patients and 7.52 ± 3.35 cm3 in patients with no shunt where P- value was 0.0001). Therefore, our study suggests that a volumetric measurement of total lateral ventricles by the 3D US could be used concurrently with other physical parameters for better management of the neonates having PHH.