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Abstract

Objectives: To evaluate the role of optic nerve sheath diameter measurement by orbital ultrasound in monitoring children with non-traumatic coma and increased ICP. Methods: A single-centre prospective observational study. conducted in the PICU of a tertiary care teaching hospital in Puducherry, INDIA. Children admitted to the PICU with features of raised ICP were enrolled. Baseline characteristics and raised ICP characteristics were recorded.ONSD measurements were taken in all children in the supine position using bedside ultrasound with a twelve MHZ linear probe. The probe was initially placed in the axial plane and measurements were taken at a distance of 3 mm posterior to the site at which the optic nerve enters the globe. Measurements were recorded sequentially 8th hourly till ICP features got resolved or the patient died. Along with each measurement, clinical parameters were recorded. The ONSD measurements were compared with clinical features. We also recruited children admitted to the PICU for other conditions without features of raised ICP as controls. We compared ONSD measurements of cases with controls. Results: 185 children were recruited, of which 81 had features of raised ICP and 104 without increased ICP. The ONSD measurements in children with raised ICP were significantly higher as compared to those without ICP. Among children with raised ICP, there was a negative correlation between ONSD and GCS scores ( r= -0.739; p < 0.0001). In children with raised ICP, there was a significant difference in ONSD at different intervals, demonstrating a falling trend from admission to 32nd-hour readings. Conclusion: ONSD measurements were higher in children with clinical signs of increased ICP compared to controls, thereby suggesting this non-invasive measure may be helpful in the neuromonitoring of children with neurologic insults.

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