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Risk factors associated with post-hemorrhagic hydrocephalus among very low birth weight infants of 24-28 weeks

G Klinger1,2, M Osovsky1,2, V Boyko3

  • 1Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

Journal of Perinatology : Official Journal of the California Perinatal Association
|March 4, 2016
PubMed

Insights

Post-hemorrhagic hydrocephalus (PHH) in very low birth weight (VLBW) infants is linked to peri-intraventricular hemorrhage (PIVH) severity, gestational age, and neonatal conditions. Bilateral severe hemorrhages pose the highest risk for PHH development.

Area of Science:

  • Neonatalogy
  • Pediatric Neurology
  • Critical Care Medicine

Background:

  • Post-hemorrhagic hydrocephalus (PHH) significantly contributes to morbidity and mortality in very low birth weight (VLBW) infants.
  • Peri-intraventricular hemorrhage (PIVH) is a common complication in VLBW infants, often preceding PHH.
  • Identifying risk factors for PHH is crucial for timely intervention and improved outcomes.

Purpose of the Study:

  • To investigate the risk factors associated with the development of PHH in VLBW infants who have experienced PIVH.
  • To determine the specific PIVH severity grades and neonatal morbidities that correlate with an increased risk of PHH.
  • To provide data that can inform clinical management strategies for VLBW infants at risk for PHH.

Main Methods:

  • A population-based cohort study included VLBW infants (24-28 weeks gestation) born between 1995 and 2012 in Israel.
  • Infants without brain ultrasound before 28 days or with major congenital malformations were excluded.
  • Univariate and multivariable analyses were performed to identify independent risk factors for PHH.

Main Results:

  • The study included 2811 VLBW infants with grade 2 or higher PIVH; 21.7% developed PHH.
  • PHH risk was independently associated with PIVH severity, with bilateral grade 3 and grade 3/contralateral grade 4 PIVH showing the highest odds ratios.
  • Increasing gestational age, patent ductus arteriosus (medically or surgically treated), sepsis, and necrotizing enterocolitis were also independently associated with PHH.

Conclusions:

  • In VLBW infants with PIVH, PHH development is independently linked to PIVH severity, increasing gestational age, and acute neonatal morbidities.
  • Unilateral grade 3 or 4 PIVH confers a moderate risk of PHH compared to bilateral severe hemorrhages.
  • These findings highlight the importance of monitoring PIVH severity and neonatal complications in VLBW infants to predict and manage PHH.
Abstract

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