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Updated: May 22, 2026
Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
Published on: March 28, 2025
Timing of external ventricular drainage and neurodevelopmental outcome in preterm infants with posthemorrhagic
Haim Bassan1, Rina Eshel, Inbal Golan
1Neonatal Neurology Service, Child Neurology and Development Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel. bassan@post.tau.ac.il
Insights
Early external ventricular drainage (EVD) in preterm infants with posthemorrhagic hydrocephalus (PHH) shows better neurodevelopmental outcomes. This approach is linked to lower rates of cognitive, communication, and social disabilities.
Area of Science:
- Neonatal Neurology
- Pediatric Neurodevelopment
- Medical Interventions
Background:
- Posthemorrhagic hydrocephalus (PHH) is a complication of intraventricular hemorrhage (IVH) in preterm infants.
- The timing of external ventricular drainage (EVD) may influence neurodevelopmental outcomes in these infants.
Purpose of the Study:
- To compare the neurodevelopmental outcomes of preterm infants with PHH based on early (≤25 days) versus late (>25 days) EVD.
- To identify if early EVD improves cognitive, communication, and social functions.
Main Methods:
- Retrospective study of 32 preterm infants with PHH.
- Infants categorized into early EVD (n=10) and late EVD (n=22) groups.
- Neurodevelopmental assessment using Battelle Developmental Inventory II and neuromotor examination at median 73 months.
Main Results:
- Early EVD associated with significantly better adaptive, personal-social, and communication scores.
- Lower rates of severe cognitive disability in the early EVD group (30% vs. 82%).
- Early EVD showed benefit in infants with grade III IVH but not with prior parenchymal injury.
Conclusions:
- Early EVD in preterm infants with PHH (without prior parenchymal injury) is linked to better neurodevelopmental outcomes.
- Results suggest reduced cognitive, communication, and social disabilities with timely EVD.
- A randomized prospective trial is recommended to confirm these findings.
Objective:
To delineate the impact of early (≤ 25 days of life) versus late (> 25 days) external ventricular drainage (EVD) on the neurodevelopmental outcome of preterm infants with posthemorrhagic hydrocephalus (PHH) following intraventricular hemorrhage (IVH).
Methods:
We retrospectively categorized 32 premature infants with PHH into two groups according to whether they underwent early (n = 10) or late (n = 22) EVD. We administered the Battelle Developmental Inventory II and a neuromotor examination (median age, 73 months, range: 29-100).
Results:
In adjusted comparisons, early EVD was associated with better scores than late EVD in adaptive (79 ± 22.6 vs. 58.8 ± 8.1, P = .01), personal social (90.7 ± 26 vs. 67.3 ± 15.9, P = .02), communication (95.4 ± 27.5 vs. 69.6 ± 20.5, P = .04) and cognitive (78.9 ± 24.4 vs. 60.7 ± 11.5, P = .055) functions. Three (30%) early EVD infants had severe (<2.5 standard deviation) cognitive disability compared to 18 (82%) late EVD infants (P = .03). The incidences of cerebral palsy and neurosurgical complications were equal for the two groups. Subgroup analyses suggested that early EVD was beneficial in infants with original grade III IVH (n = 15, P < 0.05), but that it had no beneficial effects in infants with prior parenchymal injury (n = 17, P = NS).
Conclusion:
In this small retrospective series, early EVD is associated with lower rates of cognitive, communication and social disabilities than later EVD in infants with PHH without prior parenchymal injury. A randomized prospective trial is warranted.
