The results of this study show that skin adhesive fiducial marker registration is the most accurate noninvasive registration method. When images from an earlier study are to be used and accuracy may be slightly compromised, anatomical landmarks and surface matching are equally accurate alternatives.

There was no significant difference in the primary composite outcome of VP shunt placement or death in infants with posthaemorrhagic ventricular dilatation who were treated at a lower versus a higher threshold for intervention. Infants treated at the lower threshold received more invasive procedures. Assessment of neurodevelopmental outcomes will provide further important information in assessing the risks and benefits of the two treatment approaches.

This study provides Class III evidence that for preterm infants with PHVD, an EA to management results in better neurodevelopmental outcomes than a LA.

Although frameless stereotactic brain biopsy procedures are considered to be relatively safe, the true DY is significantly less than previously reported, most probably due to the lack of standardised DY criteria. Based on our DY definition and subsequent DY findings, standardisation of DY criteria and definition is paramount for biopsy diagnosis interpretation.

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Background: There is accumulating evidence showing beneficial effects of early intervention on posthemorrhagic ventricular dilatation (PHVD) and neurologic outcomes. Objective:To compare the effect of early and late intervention for PHVD on brain injury and ventricular volume using term-equivalent age magnetic resonance imaging (TEA-MRI). Methods:In the ELVIS (Early versus Late Ventricular Intervention Study) trial 126 preterm infants ≤34 weeks gestation with PHVD after grade III-IV intraventricular hemorrhage were randomised to low threshold (LT, ventricular index (VI) > p97 and anterior horn width (AHW) > 6mm) or higher threshold (HT, VI > p97 + 4mm and AHW > 10mm). The Kidokoro Global Brain Abnormality Score and the frontal and occipital horn (FOH) ratio were measured. Automatic segmentation was used to perform volumetric measurements. Results:Of the 110 surviving infants, TEA-MRI was obtained in 88 (80%) infants, of which 44 were in the LT group and 44 in the HT group. The total Kidokoro score of the infants in the LT group was lower than in the HT group (median (interquartile range): 8 (5-12) vs 12 (9-17), respectively; p<0.001). When the groups were compared in terms of severity of the Kidokoro score, there were more infants in the LT group with a normal or mildly increased score, and more infants in the HT group with a moderately or severely increased score (46% vs. 11% and 89% vs. 54%, respectively; p=0.002). The FOH ratio was lower in the LT group, when compared with the HT group (0.42 (0.34-0.63) vs 0.48 (0.37-0.68), respectively; p=0.001). The ventricular CSF volumes were calculated in 47 infants and were smaller in the LT group (p=0.03). Conclusion:Our findings demonstrate more brain injury and larger ventricular CSF volumes in the HT group. These results contribute to the growing evidence for the positive effects of early intervention for PHVD.

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