Chan Belinda, York Dan, Ford Alison, Gleason Susie, Floyd Ivah, Gordon Sasha, Singh Yogen
Neonatology Division, Department of Pediatrics, University of California Davis Health, Sacramento, California, USA.
Neonatology Division, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
J Ultrasound Med. 2025 Oct;44(10):1773-1781. doi: 10.1002/jum.16727. Epub 2025 May 28.
Intraventricular hemorrhage (IVH) affects >15% of preterm infants. Severe IVH disrupts cerebrospinal fluid (CSF) flow dynamics, causing post-hemorrhagic ventricular dilation (PHVD) and further brain injury. Although lumbar puncture (LP) may reduce CSF volume and intracranial pressure, its effectiveness depends on brain-to-spine CSF flow dynamics and spinal CSF volume, which remain underexplored. This study correlates IVH severity with spinal CSF volume of preterm infants using spinal ultrasound (SUS).
This prospective study enrolled infants (<33 weeks gestational age [GA]) with head ultrasounds (HUS) done at 7-15 days of life. SUS was performed within 2 days of HUS and repeated if another HUS was done. Exclusion criteria were congenital, chromosomal, or spinal anomalies. Using SUS clips, an automated algorithm calculating the proportion of anechoic CSF area within the spinal canal at the L3-L4 intervertebral space, termed the CSF-to-Spinal Canal Index (CSCI) was developed. Clinical data and IVH grades were analyzed.
Twenty-five infants (mean GA: 28 ± 3 weeks) were enrolled, with 46 SUS studies performed. We found no correlation between IVH grade and CSCI (R = 0.13, P = .57). The CSCI did not correlate with birth GA, birth weight, corrected GA, current weight, day of life, and previous 24-hour weight change at the time of SUS. The CSCI decreased after each LP in 4 infants with PHVD. Four infants needed surgical CSF diversion.
SUS is a non-invasive method to estimate spinal CSF volume. The lack of correlation with IVH severity suggests multifactorial mechanisms besides previously proposed CSF outflow obstruction. Further research is necessary to understand the pathophysiology of PHVD.
脑室内出血（IVH）影响超过15%的早产儿。严重的IVH会破坏脑脊液（CSF）流动动力学，导致出血后脑室扩张（PHVD）及进一步的脑损伤。虽然腰椎穿刺（LP）可能会减少脑脊液量和颅内压，但其有效性取决于脑与脊髓之间的脑脊液流动动力学以及脊髓脑脊液量，而这些仍未得到充分研究。本研究使用脊髓超声（SUS）将早产儿的IVH严重程度与脊髓脑脊液量相关联。
这项前瞻性研究纳入了出生后7 - 15天进行了头部超声（HUS）检查的婴儿（胎龄<33周）。SUS在HUS检查后2天内进行，若再次进行HUS检查则重复SUS检查。排除标准为先天性、染色体或脊柱异常。利用SUS图像片段，开发了一种自动算法，用于计算L3 - L4椎间隙椎管内无回声脑脊液区域的比例，称为脑脊液与椎管指数（CSCI）。对临床数据和IVH分级进行分析。
共纳入25例婴儿（平均胎龄：28±3周），进行了46次SUS检查。我们发现IVH分级与CSCI之间无相关性（R = 0.13，P = 0.57）。CSCI与出生胎龄、出生体重、矫正胎龄、当前体重、检查日龄以及SUS检查时前24小时体重变化均无相关性。4例PHVD婴儿每次LP后CSCI均下降。4例婴儿需要进行手术性脑脊液分流。
SUS是一种估计脊髓脑脊液量的非侵入性方法。与IVH严重程度缺乏相关性表明，除了先前提出的脑脊液流出道梗阻外，还存在多因素机制。有必要进一步研究以了解PHVD的病理生理学。
