272 - Relationship between ventricular size on latest ultrasonogram and Bayley scores in extremely low gestational age neonates (ELGANs)

Poster Number: 272
Publication Number: 272.225

Luc P. Brion, University of Texas Southwestern Medical School, Dallas, TX, United States; Jordan D. Reis, Baylor Scott & White, Prosper, TX, United States; Timothy Hagan, University of Texas Southwestern Medical School, Dallas, TX, United States; Roy Heyne, UT Southwestern: The University of Texas Southwestern Medical Center, Dallas, TX, United States; Kristine Tolentino-Plata, UT Southwestern, Murphy, TX, United States; Rebekah Clarke, Children's Health, University of Texas Southwestern, Dallas, TX, United States; Larry S. Brown, Parkland Health & Hospital System, Dallas, TX, United States

Background:
A ventricle-to-brain index (VBI) >0.35 was reported as the most significant factor predicting the average of cognitive and language Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) scores < 80 in preterm infants with birthweight < 1250 g (Hou et al 2019). Because BSID III may underestimate cognitive impairment, several authors have used a cognitive score of < 85 to define moderate to severe cognitive delay (Adams-Chapman et al 2018).

Objective: To determine whether VBI was associated with low BSID III scores defined as motor, cognitive or language scores < 85 in ELGANs.

Design/Methods:
Single-center retrospective cohort study including ELGANs born at 23 wks 0/7 – 28 wks 6/7  gestational age delivered at Parkland Hospital between July 2012 and October 2017 who completed BSID-III testing at  ≥18 months adjusted age. VBI was measured by a radiologist as the ratio of sum of bilateral ventricular index measurements (distance from the falx to the lateral border of the lateral ventricle in a coronal view taken at the level of the Foramen of Monroe) to the maximum width of the skull on the latest ultrasonogram obtained before discharge home. Data on VBI were compared with radiologist's reading of ventriculomegaly in the electronic health record (EHR). The first 50 independent measurements from 2 radiologists were compared using the intraclass correlation coefficient. Statistics included chi-square analysis and forward stepwise logistic regression analysis.

Results:
The cohort included 272 neonates (Table 1). The intraclass correlation coefficient of VBI was 0.934 (95% CI 0.887, 0.962). VBI was significantly associated with the percentage of low motor and cognitive but not language Bayley III scores in bivariate (Table 2) and multivariate analysis (Table 3). VBI was significantly greater in the 10 infants who had ventricular dilation listed in the EHR  compared with those who did not [0.43±0.10 (mean±SD) vs 0.29±0.04 P< 0.001]. A radiologist reading of ventricular dilation was associated with low motor BSID Scores (70% vs 30% without ventricular dilation, P=0.008) but not cognitive scores (70% vs 50%, P=0.21) in bivariate analysis, but was not associated with BSID scores in multivariate analyses.
Conclusion(s): The measurement of VBI had excellent reliability. VBI >0.35 was significantly associated with the percentage of low Bayley III motor and cognitive but not language scores.
Table 1. Maternal and Neonatal characteristics
Table 2. The Percentages of Low ( < 85) Motor & Cognitive Bayley Scores are Associated with Ventricle to Brain Index.