Estimation of elevated intracranial pressure in infants with hydroce-phalus by using transcranial Doppler velocimetry with fontanel compression

Teiko Yoshizuka, Masahiro Kinoshita, Sachiko Iwata, Kennosuke Tsuda, Takenori Kato, Mamoru Saikusa, Ryota Shindou, Naoko Hara, Eimei Harada, Sachio Takashima, Nobuyuki Takeshige, Shinji Saitoh (+2 others)
2018 Scientific Reports  
For infants with acute progressive hydrocephalus, invasive drainage of cerebrospinal fluid (CSF) is performed until a ventriculo-peritoneal shunt can be inserted. Surrogate markers of intracranial pressure (ICP) may help optimise the timing of invasive procedures. To assess whether RI with/without fontanel compression helps distinguish between infants with normal (<5 cmH 2 O), mild (5-11 cmH 2 O), and moderate (>11 cmH 2 O) ICP elevation, 74 ICP measures before/after CSF removal and 148 related
more » ... Doppler measures of the middle cerebral artery were assessed. Higher RI was associated with fontanel compression, elevated ICP, and their interaction (all p < 0.001). Without compression, differences in RI were observed between normal and moderate (p < 0.001) and between mild and moderate ICP elevation (p = 0.033). With compression, differences in RI were observed for all pairwise comparisons among normal, mild, and moderate ICP elevation (all p < 0.001). Without compression, areas under the receiver-operating characteristic curve for prediction of mild and moderate ICP elevation were 0.664 (95% confidence interval (CI), 0.538-0.791; p = 0.020) and 0.727 (95% CI, 0.582-0.872; p = 0.004), respectively, which improved to 0.806 (95% CI, 0.703-0.910; p < 0.001) and 0.814 (95% CI, 0.707-0.921; p < 0.001), respectively, with compression. RI with fontanel compression provides improved discrimination of infants with absent, mild, and moderate ICP elevation.
doi:10.1038/s41598-018-30274-3 pmid:30087390 pmcid:PMC6081432 fatcat:wt6hqaneejephgiweccdohvf44