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Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt
Ira Adams-Chapman1, Nellie I Hansen, Barbara J Stoll
1Department of Pediatrics/Division of Neonatology, Emory University School of Medicine, 46 Jesse Hill Jr Drive SE, Atlanta, GA 30303, USA. ira_adams-chapman@oz.ped.emory.edu
Insights
Extremely low birth weight infants needing shunts for severe intraventricular hemorrhage face worse neurodevelopmental and growth outcomes. These infants showed lower cognitive scores and higher risks for cerebral palsy.
Area of Science:
- Neonatal research
- Pediatric neurology
- Developmental pediatrics
Background:
- Severe intraventricular hemorrhage (IVH) is a significant complication in extremely low birth weight (ELBW) infants.
- Shunt insertion is sometimes necessary to manage hydrocephalus secondary to severe IVH.
- Outcomes for ELBW infants requiring shunts for IVH are not well-defined.
Purpose of the Study:
- To compare neurodevelopmental and growth outcomes in ELBW infants with severe IVH who underwent shunt insertion versus those without shunt insertion.
- To identify specific risks associated with shunt placement in this vulnerable population.
Main Methods:
- A retrospective cohort study of ELBW infants (401-1000g) born between 1993-2002.
- Infants were categorized into five groups based on IVH grade (3 or 4) and shunt status.
- Neurodevelopmental assessments (Bayley Scales) and growth parameters were evaluated at 18-22 months corrected age.
Main Results:
- Infants with severe IVH requiring shunts demonstrated significantly lower Bayley Scores compared to controls.
- Shunt placement was associated with an increased risk of cerebral palsy.
- Head circumference below the 10th percentile was more common in infants with shunts.
Conclusions:
- ELBW infants with severe IVH necessitating shunt insertion face heightened risks for adverse neurodevelopmental and growth outcomes.
- These findings highlight the critical impact of shunt intervention on long-term development in this cohort.
- Further long-term follow-up is crucial to ascertain the persistence of these developmental challenges.
Objective:
We aimed to evaluate neurodevelopmental and growth outcomes among extremely low birth weight infants who had severe intraventricular hemorrhage that required shunt insertion compared with infants without shunt insertion.
Methods:
Infants who were born in 1993-2002 with birth weights of 401 to 1000 g were enrolled in a very low birth weight registry at medical centers that participate in the National Institute of Child Health and Human Development Neonatal Research Network, and returned for follow-up at 18 to 22 months' corrected age were studied. Eighty-two percent of survivors completed follow-up, and 6161 children were classified into 5 groups: group 1, no intraventricular hemorrhage/no shunt (n = 5163); group 2, intraventricular hemorrhage grade 3/no shunt (n = 459); group 3, intraventricular hemorrhage grade 3/shunt (n = 103); group 4, intraventricular hemorrhage grade 4/no shunt (n = 311); and group 5, intraventricular hemorrhage grade 4/shunt (n = 125). Group comparisons were evaluated with chi(2) and Wilcoxon tests, and regression models were used to compare outcomes after adjustment for covariates.
Results:
Children with severe intraventricular hemorrhage and shunts had significantly lower scores on the Bayley Scales of Infant Development IIR compared with children with no intraventricular hemorrhage and with children with intraventricular hemorrhage of the same grade and no shunt. Infants with shunts were at increased risk for cerebral palsy and head circumference at the <10th percentile at 18 months' adjusted age. Greatest differences were observed between children with shunts and those with no intraventricular hemorrhage on these outcomes.
Conclusions:
This large cohort study suggests that extremely low birth weight children with severe intraventricular hemorrhage that requires shunt insertion are at greatest risk for adverse neurodevelopmental and growth outcomes at 18 to 22 months compared with children with and without severe intraventricular hemorrhage and with no shunt. Long-term follow-up is needed to determine whether adverse outcomes persist or improve over time.
