Advanced MRI in IVH

Background Post-haemorrhagic ventricular dilatation (PHVD) is the most important cause of developmental and cognitive disability after prematurity. The ENLIVEN-UK trial is an NIHR-funded multicentre national randomised study, aiming to recruit 100 neonates across 16 centres, to evaluate the impact of endoscopic lavage in addition to standard drainage of cerebrospinal fluid (CSF) at an early postnatal age. In this study we will use a set of novel MRI sequences at term-equivalent age (TEA) to assess impact of treatment and discover novel mechanisms of disease. Objectives 1. To determine the impact of standard treatment and endoscopic lavage on brain structure and function, distribution of blood products, and CSF flow using advanced MRI techniques at TEA; 2. To assess how these new MRI techniques relate to prognosis, and add predictive value to the basic MRI scan carried out as standard of care, as defined by the 2-year structured formal evaluation within the ENLIVEN-UK trial and 6-monthly neurological examinations. Methods Neonates with PHVD undergoing neurosurgical treatment at Great Ormond Street Hospital (GOSH) and Alder Hey Children's Hospital (AHCH) (15 neonates in each), the majority of whom will be recruited to the ENLIVEN-UK study, will undergo additional novel MRI sequences at their TEA MRI scan. These will include Diffusion Tractography (DTI), DTI-along perivascular spaces (DTI-ALPS), quantitative susceptibility mapping (QSM) and resting state functional MRI (rs-fMRI) sequences. These images will be processed and evaluated by MR physicists and outcomes will be reviewed in the context of their (a) randomised surgical treatment and (b) formal developmental and cognitive evaluation at 2 years. Outcomes The use of these MR sequences in this population is novel. Any factors related to the impact of endoscopic lavage and prognostic significance will be evaluated in a wider neonatal cohort through the national network of neurosurgeons and neonatologists developed by the ENLIVEN-UK study.