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Intraventricular hemorrhage and posthemorrhagic hydrocephalus in the preterm infant

P Miranda1

  • 1Department of Pediatric Neurosurgery, Hospital La Fe, Valencia, Spain. mirandalloret@yahoo.es

Minerva Pediatrica
|March 10, 2010
PubMed

Insights

Germinal matrix-intraventricular hemorrhage and posthemorrhagic hydrocephalus are serious neurological issues in preterm infants. Prevention of prematurity is crucial to reduce the number of infants requiring cerebrospinal fluid shunts.

Area of Science:

  • Neonatal Neurology
  • Pediatric Neurosurgery

Background:

  • Intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) are major neurological complications in preterm infants.
  • Incidence of germinal matrix-intraventricular hemorrhage (GMH-IVH) varies widely (5%-90%) and is inversely related to gestational age.
  • Higher-grade hemorrhages are more common in low-birth weight neonates, leading to poor neurodevelopmental outcomes like seizures and motor deficits.

Purpose of the Study:

  • To review the pathogenesis, diagnosis, and treatment of intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants.
  • To highlight the importance of cranial ultrasound in diagnosis and current treatment modalities.
  • To emphasize the role of prematurity prevention in reducing shunt dependency.

Main Methods:

  • Review of literature on germinal matrix hemorrhage pathogenesis, clinical presentation, diagnostic tools, and treatment strategies.
  • Analysis of factors contributing to cerebral blood flow alterations in preterm infants.
  • Evaluation of the efficacy and complications of current treatments, including CSF shunting.

Main Results:

  • Germinal matrix hemorrhage pathogenesis involves intravascular, vascular, and extravascular factors affecting cerebral blood flow and CNS pressure.
  • Cranial ultrasound is essential for definitive diagnosis, as clinical criteria alone are insufficient.
  • Permanent CSF shunts are the only proven treatment for progressive PHH but have frequent complications.

Conclusions:

  • Intraventricular hemorrhage and posthemorrhagic hydrocephalus significantly impact preterm infant neurodevelopment.
  • Effective diagnosis relies heavily on cranial ultrasound.
  • Preventing prematurity is the most effective strategy to decrease the incidence of posthemorrhagic hydrocephalus and subsequent shunt dependency.

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