What should we do now?
I think we should stop using the Papile classification.
We should clarify that an intraventricular hemorrhage with acute hemorrhagic dilatation of the ventricle(s) is not the same pathophysiology as a hemorrhage followed by dilatation. (stage 2 followed by PHVD compared to a stage 3)
We should differentiate between an acute intra-parenchymal echodensity (which may be hemorrhagic or edematous) and PVHI, associated with intraventricular blood on the ispilateral side.
We should analyze and record the brain regions affected by the PVHI or IPE.
We should follow, and report the outcomes, of several hundreds of individuals, in order to have reliable information.
In other words, we should abandon the Papile classification, we should use descriptive terms to interpret head ultrasounds, we should use published percentiles to determine if a ventricle is dilated or not, we should record the brain regions affected on ultrasound, unilateral and bilateral, and we should work at correlating these findings with long-term outcomes.
I cannot agree more.
Until we change to a classification system that reflects and discriminates etiology we will not be able to adequately study prevention of preterm brain injury or develop quality improvement interventions that make sense. I suggest the following:
-We should stop using “IVH” to describe all brain injury.
-We should stop using “grade” to describe lesions with unrelated causation.
-We should probably stop doing head ultrasounds in stable preterm babies as they are poor “screening” tests.
Until we get this right we will be fumbling to improve rates of preterm brain injury.
Thanks for the comment, I agree entirely, and particularly with the last point, I think the only really valid reason for doing head ultrasounds is to search for potentially treatable lesions, i.e. post-hemorrhagic ventricular dilatation. You could accomplish that with targeted ultrasounds in the second week of life for babies who have a significant risk. All we accomplish with routine ultrasounds is to find lesions of questionable significance (increased peri-ventricular echogenicity most frequently), and then make parents worry for no good reason.