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Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation : A Nested Substudy of the Randomized Controlled ELVIS Trial

Cizmeci, Mehmet N ; Khalili, Nadieh ; Claessens, Nathalie H P ; Groenendaal, Floris ; Liem, Kian D ; Heep, Axel ; Benavente-Fernández, Isabel ; van Straaten, Henrica L M ; van Wezel-Meijler, Gerda and Steggerda, Sylke J , et al. (2019) In Journal of Pediatrics 208. p.2-197
Abstract

OBJECTIVE: To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI.

STUDY DESIGN: In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for... (More)

OBJECTIVE: To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI.

STUDY DESIGN: In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis.

RESULTS: The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P < .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03).

CONCLUSIONS: More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation.

TRIAL REGISTRATION: ISRCTN43171322.

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Contribution to journal
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published
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keywords
Brain/diagnostic imaging, Brain Injuries/diagnostic imaging, Cerebral Hemorrhage/diagnostic imaging, Cerebral Ventricles/diagnostic imaging, Cerebrospinal Fluid, Cerebrospinal Fluid Shunts, Dilatation, Female, Humans, Hydrocephalus/diagnostic imaging, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases/diagnostic imaging, Intracranial Hemorrhages/diagnostic imaging, Magnetic Resonance Imaging, Male, White Matter/diagnostic imaging
in
Journal of Pediatrics
volume
208
pages
2 - 197
publisher
Academic Press
external identifiers
  • scopus:85062713479
  • pmid:30878207
ISSN
1097-6833
DOI
10.1016/j.jpeds.2018.12.062
language
English
LU publication?
yes
additional info
Copyright © 2019 Elsevier Inc. All rights reserved.
id
9b88ec94-2d70-4cb9-be62-3af044767dd1
date added to LUP
2023-10-19 12:22:12
date last changed
2024-04-19 02:36:05
@article{9b88ec94-2d70-4cb9-be62-3af044767dd1,
  abstract     = {{<p>OBJECTIVE: To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI.</p><p>STUDY DESIGN: In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index &gt;p97 and anterior horn width &gt;6 mm) or high-threshold (ventricular index &gt;p97 + 4 mm and anterior horn width &gt;10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis.</p><p>RESULTS: The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P &lt; .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03).</p><p>CONCLUSIONS: More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation.</p><p>TRIAL REGISTRATION: ISRCTN43171322.</p>}},
  author       = {{Cizmeci, Mehmet N and Khalili, Nadieh and Claessens, Nathalie H P and Groenendaal, Floris and Liem, Kian D and Heep, Axel and Benavente-Fernández, Isabel and van Straaten, Henrica L M and van Wezel-Meijler, Gerda and Steggerda, Sylke J and Dudink, Jeroen and Išgum, Ivana and Whitelaw, Andrew and Benders, Manon J N L and de Vries, Linda S}},
  issn         = {{1097-6833}},
  keywords     = {{Brain/diagnostic imaging; Brain Injuries/diagnostic imaging; Cerebral Hemorrhage/diagnostic imaging; Cerebral Ventricles/diagnostic imaging; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Dilatation; Female; Humans; Hydrocephalus/diagnostic imaging; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases/diagnostic imaging; Intracranial Hemorrhages/diagnostic imaging; Magnetic Resonance Imaging; Male; White Matter/diagnostic imaging}},
  language     = {{eng}},
  pages        = {{2--197}},
  publisher    = {{Academic Press}},
  series       = {{Journal of Pediatrics}},
  title        = {{Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation : A Nested Substudy of the Randomized Controlled ELVIS Trial}},
  url          = {{http://dx.doi.org/10.1016/j.jpeds.2018.12.062}},
  doi          = {{10.1016/j.jpeds.2018.12.062}},
  volume       = {{208}},
  year         = {{2019}},
}