College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Division of Neonatology, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Neonatology. 2019;116(1):1-5. doi: 10.1159/000497163. Epub 2019 Mar 19.
In preterm infants, early diagnosis and management of a raised intracranial pressure (ICP) may be important to improve neurodevelopmental outcomes. While invasive ICP monitoring is not recommended, ultrasonography of the optic nerve sheath diameter (ONSD) could provide a noninvasive alternative to evaluate ICP. The objective of this pilot study was to document ranges of ONSD in preterm infants.
This prospective cohort pilot evaluated preterm infants who were admitted to the neonatal intensive care unit without suspected raised ICP. Three images per eye were obtained from a 20-5 MHz linear array ultrasound transducer placed on the patient's superior eyelid. The OSND was measured 3 mm behind the globe. A second ultrasonographer duplicated half of the scans. Multiple linear regression analysis was conducted for both right and left ONSD with corrected gestational age, weight, and head circumference as predictors. Lin's concordance assessed interrater reliability.
In 12 preterm infants 114 scans were performed on both eyes. The median age was 33 weeks (corrected gestational age) with a range of 29-36 weeks. Corrected gestational age was the strongest predictor for ONSD, and preliminary measurements at each gestational age were established. Interrater reliability demonstrated substantial agreement (Qc = 0.97).
In preterm infants, ONSD strongly correlates with corrected gestational age. These data should be validated with other imaging modalities before abnormal ranges can be considered.
在早产儿中，早期诊断和处理颅内压升高（ICP）可能对改善神经发育结局很重要。虽然不建议进行有创 ICP 监测，但视神经鞘直径（ONSD）超声检查可能提供一种替代方法，用于评估 ICP。本初步研究的目的是记录早产儿的 ONSD 范围。
这项前瞻性队列初步研究评估了入住新生儿重症监护病房且无疑似 ICP 升高的早产儿。使用放置在患者上眼睑的 20-5MHz 线性阵列超声换能器，每只眼睛获得 3 个图像。在眼球后 3mm 处测量 ONSD。第二位超声医师对一半的扫描进行了重复测量。使用校正胎龄、体重和头围作为预测因子，对右和左 ONSD 进行多元线性回归分析。采用 Lin 的一致性评估评价者间的可靠性。
在 12 名早产儿中，对双眼进行了 114 次扫描。中位胎龄为 33 周（校正胎龄），范围为 29-36 周。校正胎龄是 ONSD 的最强预测因子，并建立了每个胎龄的初步测量值。评价者间可靠性显示出高度一致性（Qc=0.97）。
在早产儿中，ONSD 与校正胎龄密切相关。在可以考虑异常范围之前，这些数据应与其他成像方式进行验证。
