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Correlation of ventricular size and head circumference after severe intra-periventricular haemorrhage in preterm
1Department für Neonatologie, Universitäts-Kinderklinik, Graz, Austria.
Insights
Ventricular width (VW) in premature infants with intraventricular hemorrhage is key. A VW over 1.5 cm indicates hydrocephalus, while head growth rate is a poor indicator.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
- Perinatal medicine
Background:
- Intraventricular hemorrhage (IVH) is a common complication in premature infants.
- Progressive ventricular dilation can lead to hydrocephalus, impacting neurological outcomes.
- Current diagnostic criteria for post-hemorrhagic hydrocephalus lack precision.
Purpose of the Study:
- To investigate the correlation between ventricular width (VW) and occipitofrontal circumference (OFC) growth rate in premature infants with IVH.
- To identify reliable indicators for predicting progressive ventricular dilation and hydrocephalus.
- To evaluate the efficacy of the 2 cm/week OFC growth rate criterion.
Main Methods:
- Retrospective study of premature infants with IVH.
- Categorization into two groups based on clinical course: no raised intracranial pressure (Group A) and developing progressive ventricular dilation (Group B).
- Objective measurement of ventricular width (VW) and occipitofrontal circumference (OFC) growth rate.
Main Results:
- A VW between 0.9 and 1.4 cm did not impede normal head growth in Group A.
- A VW exceeding 1.5 cm was consistently associated with hydrocephalus development.
- An OFC growth rate exceeding 2 cm/week proved to be an unreliable predictor of post-hemorrhagic hydrocephalus.
Conclusions:
- Ventricular width is a more accurate predictor of hydrocephalus than head growth rate in premature infants with IVH.
- A ventricular width threshold of 1.5 cm can aid in the early identification of hydrocephalus.
- Re-evaluation of diagnostic criteria for post-hemorrhagic hydrocephalus is warranted.
Abstract:
No detailed information is available about the timing and correlation of objectively gauged ventricular width (VW) and the rate of growth of the occipitofrontal circumference in premature infants with intraventricular haemorrhage preceding progressive ventricular dilation. For this study, two groups were selected according to clinical course: group A (n = 6) had ventriculomegaly with no signs of raised intracranial pressure, while patients in group B (n = 7) developed progressive ventricular dilation after a period of latency. A VW between 0.9 and 1.4 cm (group A) did not affect normal head growth, whereas a VW greater than 1.5 cm was always associated with the development of hydrocephalus. Our data further suggest that the widely used criterion of a head growth rate of more than 2 cm/week is a relatively poor criterion for the definition of post-haemorrhagic hydrocephalus.