Cranial ultrasound-based prediction of post hemorrhagic hydrocephalus outcome in premature neonates with intraventricular hemorrhage

Premature neonates with intraventricular hemorrhage (IVH) followed by post hemorrhagic hydrocephalus (PHH) are at high risk for brain injury. Cranial ultrasound (CUS) is used for monitoring of premature neonates during the first weeks after birth to identify IVH and follow the progression to PHH. However, the lack of a standardized method for CUS evaluation has led to significant variability in decision making regarding treatment. We propose a quantitative imaging tool for the evaluation of PHH on CUS for premature neonates based on morphological features of the cerebral ventricles. We retrospectively studied 64 extremely premature neonates born less than 29 weeks gestational age, less than 1,500 grams weight at birth, admitted to our center within two weeks of life, and diagnosed with different grades of IVH. We extracted morphological features of the lateral ventricles from CUS imaging using image analysis techniques to compare neonates who needed a temporizing intervention to treat PHH to the ones who did not. From the original set of features, an optimal ranking was obtained based on linear support vector machine. A subset of features was subsequently selected that maximizes the overall accuracy level. Regarding whether or not there was a need for temporizing intervention, we predicted the outcome of PHH with an improved accuracy level of 84%, compared to the 76% rate obtained by linear manual measurement. The proposed imaging tool allowed us to establish a quantitative method for PHH evaluation on CUS in extremely premature neonates with IVH. Further studies will help standardize the evaluation of CUS in those neonates to institute treatments earlier and improve outcomes.