Prediction of post-hemorrhagic ventricular dilatation trajectory using a growth mixture model in preterm infants

Grace M Musiime; Khorshid Mohammad; Sarfaraz Momin; Grace P S Kwong; Jay Riva-Cambrin; James Scott; Hussein Zein; Leonora Hendson; Lara M Leijser

doi:10.1038/s41390-024-03396-w

Prediction of post-hemorrhagic ventricular dilatation trajectory using a growth mixture model in preterm infants

Pediatr Res. 2024 Jul 9. doi: 10.1038/s41390-024-03396-w. Online ahead of print.

Authors

Grace M Musiime¹, Khorshid Mohammad¹, Sarfaraz Momin¹, Grace P S Kwong^{2

3

4}, Jay Riva-Cambrin⁵, James Scott⁶, Hussein Zein¹, Leonora Hendson^{1

2}, Lara M Leijser^{7

8

9}

Affiliations

¹ Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
² Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
³ Department of Community Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁴ Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.
⁵ Division of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷ Department of Pediatrics, Section of Newborn Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. lara.leijser@ucalgary.ca.
⁸ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. lara.leijser@ucalgary.ca.
⁹ Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. lara.leijser@ucalgary.ca.

PMID: 38982166
DOI: 10.1038/s41390-024-03396-w

Abstract

Background: Early intervention for post-hemorrhagic ventricular dilatation (PHVD), guided by ventricular size measurements from cranial ultrasound (cUS), is associated with improved neurodevelopmental outcomes in preterm infants but benefits must be balanced against intervention risks.

Methods: Anterior horn width (AHW) and ventricular index (VI) were measured from cUS for preterm infants (<29 weeks) with intraventricular hemorrhage admitted from 2010-2018. PHVD was defined as AHW > 6 mm or VI >97th percentile for postmenstrual age. Individual ventricular size trajectories were plotted, and a growth mixture model (GMM) used to identify latent trajectory classes and compare these to predetermined outcome of neurosurgical intervention.

Results: Measurements were obtained from 1543 cUS in 249 infants, of whom 39 had PHVD without and 17 PHVD with neurosurgical intervention based on signs of raised intracranial pressure. The GMM predicted trajectory identified: 93.3% of infants without PHVD, 88.2% and 30.8% of infants with PHVD with and without intervention using AHW; 100% of infants without PHVD, 52.9% and 59.0% of infants with PHVD with and without intervention using VI.

Conclusions: The AHW GMM identified a significant proportion of infants with severe PHVD. Model refinement offers a promising approach for identifying differences in PHVD trajectory at an early stage to guide management.

Impact: It is difficult to distinguish the trajectory of PHVD in the early stage of development, in particular PHVD that spontaneously arrests from slowly progressive PHVD which eventually requires intervention. We report the first modeling-based evaluation of PHVD trajectory for the prediction of short-term outcome of PHVD progression and neurosurgical intervention. With additional clinical validation and optimization to increase accuracy, predictive modeling has the potential to identify important differences in PHVD trajectory at an early stage in the clinical course, allowing for more individualized data-driven risk-benefit assessments to guide decisions on early intervention.