458 - 3D ultrasound and functional near infrared spectroscopy for bedside monitoring of intraventricular hemorrhage in preterm infants

Poster Number: 458
Publication Number: 458.342

Lilian Kebaya, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Kevin M. Stubbs, BrainsCAN, Western University, London, ON, Canada; Marcus Lo, Queen's University Faculty of Health Sciences, Kingston, ON, Canada; Paige Meyerink, LHSC, London, ON, Canada; Keith St Lawrence, Lawson Health Research Institute, London, ON, Canada; Sandrine de Ribaupierre, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Emma G. Duerden, Western University, London, ON, Canada

Background: Intraventricular hemorrhage (IVH) remains a significant cause of adverse neurodevelopmental outcomes in preterm infants. Current management options for IVH rely on serial 2-dimensional cranial ultrasound (2D US) ventricular measurements and clinical signs. Debate is ongoing concerning the optimal timing of intervention to improve long-term outcomes, particularly cerebral palsy (CP). Precise assessment and management of the degree of ventricular dilatation to guide timely intervention are critical. A need still exists for reliable biomarkers to aid in the early detection of CP. The ultimate goal of this study was to incorporate newer bedside biomarkers: 3-dimensional cranial US (3DUS) and functional infrared spectroscopy (fNIRS), to monitor and predict intervention thresholds for infants with IVH.

Objective: 1. To examine the association of ventricular morphology with cortical hemodynamic changes in preterm infants assessed using 3D US and multichannel fNIRS

Design/Methods: Preterm infants < 32 weeks’ gestation were enrolled in a prospective cohort study from the neonatal intensive care unit after a diagnosis of IVH was made during standard cranial US screening. Infants underwent sequential measurements (3DUS screening and fNIRS). A Philips HDI 5000 US machine was used to image ventricles. US images were manually segmented using in-house developed software. The software created 3D images of the ventricles, from which a volume measurement was provided. Resting state fNIRS data were acquired using a multichannel fNIRS system, while infants lie in incubator and cap positioned on infant’s head, for a minimum of 6 minutes. Optodes were positioned at predefined locations (see Fig 1a). Data quality was assessed using QT-NIRS. Preprocessing and spontaneous functional connectivity were conducted using NIRS Brain AnalyzlR Toolbox.

Results: 25 infants with IVH were enrolled in the study: 6 with grade I, 9 with grade II, 3 with grade III, and 7 with grade IV IVH. The cohort was heterogeneous and varied in terms of baseline characteristics. In neonates with severe forms of IVH (grade III-IV), larger ventricular volumes were detected by 3DUS (Fig 1b), and corresponding changes in oxy- and deoxyhemoglobin concentrations and decreased connectivity were observed. (Fig 1c).Conclusion(s): Findings demonstrating an association among ventricular size and reduced functional connectivity and cerebral flow suggest a potential mechanism underlying adverse developmental outcomes in very preterm-born infants. Our results indicate that 3DUS and fNIRS are promising bedside tools for monitoring IVH in preterm infants.
Lilian M N Kebaya-CV_2021-2.pdf