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Neonatal intracranial hemorrhage in premature infants
Insights
Neonatal intracranial hemorrhage survivors may develop hydrocephalus. This study of premature infants found varied neurological outcomes, with some developing normally after surgical drainage.
Area of Science:
- Neonatal care
- Pediatric neurology
Background:
- Neonatal intracranial hemorrhage (NIH), particularly intraventricular hemorrhage, is a significant concern in premature infants.
- Survivors of NIH often develop post-hemorrhagic hydrocephalus, impacting neurological outcomes.
Purpose of the Study:
- To retrospectively evaluate the clinical course and neurological outcomes of premature infants with hydrocephalus secondary to neonatal intracranial hemorrhage.
- To identify factors influencing neurological sequelae in this population.
Main Methods:
- Retrospective analysis of 11 premature infants born between 1968-1972 diagnosed with hydrocephalus post-NIH.
- Review of perinatal history, laboratory data, clinical evolution, and neurological assessments.
- Surgical drainage of hydrocephalus was performed in eight infants.
Main Results:
- Nine of the 11 infants survived, with two deaths occurring at 3 and 17 months.
- Two distinct groups emerged: those with acute neonatal neurological deterioration and severe sequelae (including periventricular lesions), and those without obvious neonatal signs.
- Two infants in the latter group showed normal development.
Conclusions:
- Neonatal intracranial hemorrhage in premature infants is not uniformly fatal, but survivors frequently develop hydrocephalus.
- Early neurological signs in the neonatal period correlate with more severe neurological sequelae.
- Surgical intervention for hydrocephalus is a critical therapeutic consideration with variable outcomes.
Abstract:
Since the advent of modern methods of neonatal care, intracranial hemorrhage in premature infants, which is usually intraventricular, is probably not as uniformly fatal as generally admitted and the survivors are likely to develop post-hemorrhagic hydrocephalus. This paper is a retrospective study of 11 premature babies born between 1968 and 1972 and diagnosed as having hydrocephalus secondary to neonatal intracranial hemorrhage. Nine of these are still alive and two have died, one at 3 and one at 17 months of age. Eight underwent permanant surgical drainage of hydrocephalus. The perinatal history, laboratory data, clinical evolution, and neurological outcome were studied. Two groups of infants were identified; those with signs of acute neurological deterioration in the neonatal period who had the most severe neurological sequellae (in four cases, periventricular lesions in addition to hydrocephalus were seen on the air study and in one case confirmed at autopsy) and those showing no obvious neurological signs in the neonatal period. Of this latter group, two appear to be developing normally. The therapeutic implications of the findings are discussed.