Ultrasonographic indicators in predicting postnatal outcomes of antenatally detected ventriculomegaly

Kim, Yun Hwan; Lee, Si Eun; Park, Chan Wook; Sohn, Yoo Kyung; Oh, Soo Young; Shim, Soon Sup; Park, Joong Shin; Jun, Jong Kwan; Yoon, Bo Hyun; Syn, Hee Chul

Abstract

OBJECTIVE
The aim of this study was to find out the prognostic indicators of antenatally detected ventriculomegaly.
METHODS
During the study period (Nov. 1995 through Jan. 2003), we identified 96 cases of fetal ventriculomegaly and reviewed their antenatal and postnatal follow-up records retrospectively. Excluding cases of termination before viable stage and incomplete follow-up, 68 cases were evaluated. Severe ventriculomegaly (fetal hydrocephalus; n=30) was defined as lateral ventricular atrial width (LVAW) greater than 15 mm, and mild ventriculomegaly (n=38) was defined as LVAW between 10 and 15 mm. Subgroup of LVAW <12 mm (n=23) was also analyzed. Antenatal workup included detailed ultrasonography, TORCH test and karyotyping. Outcome parameters were the presence of progressive lesion, NICU admission, shunt operation and critical damage that included delayed development, cerebral palsy and death after live birth.
RESULTS
Overall survival rate was 89.7% (61/68) and the median postnatal follow-up duration was 17.0 (0.0-69.3) months. Severe ventriculomegaly group showed higher incidence of progressive lesion, NICU admission and shunt operation than did mild group. Within mild ventriculomegaly group, critical damage was more common in cases with associated anomalies, and this difference was present even in the subgroup of LVAW <12 mm (2/16 vs. 4/7, p<0.05).
CONCLUSION
In mild ventriculomegaly group, comprehensive antenatal workup including detailed ultrasonography is important because associated anomaly is a poor prognostic factor, even in cases of LVAW <12 mm. In terms of critical damage such as developmental delay, cerebral palsy and postnatal death, the prognosis of cases with mild ventriculomegaly is also guarded.