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Posthemorrhagic hydrocephalus in high-risk preterm infants: natural history, management, and long-term outcome
F D Dykes1, B Dunbar, A Lazarra
1Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Atlanta, GA.
Insights
Posthemorrhagic hydrocephalus in infants often resolves or stabilizes, with medical management showing comparable outcomes to surgical intervention. Poor outcomes are linked to severe intraventricular hemorrhage and prematurity.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Perinatal Medicine
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in premature infants, potentially leading to posthemorrhagic hydrocephalus (PHH).
- Understanding the natural history and effective management of PHH is crucial for improving infant outcomes.
Purpose of the Study:
- To prospectively study the natural history, medical management, and outcomes of infants with PHH following IVH.
- To compare outcomes between different management strategies and analyze factors influencing long-term results.
Main Methods:
- Prospective study of infants with IVH, focusing on PHH development and progression.
- Comparison of management protocols including close observation and serial lumbar punctures for asymptomatic severe PHH.
- Long-term outcome assessment at 1-2 years and >3 years, and again at 3-6 years.
Main Results:
- PHH developed in 13% of infants with IVH; progression arrested or regressed in most cases.
- Asymptomatic severe PHH was common, with close observation yielding similar shunt-free rates as lumbar punctures.
- Long-term outcomes did not differ between infants with arrested PHH progression and those progressing to asymptomatic severe PHH.
Conclusions:
- Poor outcomes in infants with IVH and PHH are primarily associated with hemorrhage severity and early gestational age (<30 weeks).
- Medical management is a viable approach for infants with PHH, as long-term outcomes are comparable to those with arrested disease progression.
Abstract:
The natural history, medical management, and outcome in infants with progressive posthemorrhagic hydrocephalus after intraventricular hemorrhage were studied prospectively. Infants with asymptomatic severe posthemorrhagic hydrocephalus were managed with a predetermined protocol. Outcome between groups at 1 to 2 years and at more than 3 years was compared. The natural history study, restricted to the inborn population, revealed that posthemorrhagic hydrocephalus developed in 53 of 409 infants with intraventricular hemorrhage. The progression of hydrocephalus either was arrested or regressed in 35 of 53 infants; progression to severe hydrocephalus occurred in 18 of 53 infants. The severe posthemorrhagic hydrocephalus was asymptomatic in 16 of 18 infants. The management and outcome study included both inborn and outborn infants. Of 50 infants, 12 had symptomatic severe hydrocephalus and 38 had asymptomatic severe hydrocephalus. The 16 infants managed with close observation were as likely to remain shunt free as the 22 infants managed with serial lumbar punctures. Of 38 infants, 20 were managed without shunts. At 3 to 6 years, the outcome of infants in the close observation group did not differ from that in the lumbar puncture group. Long-term outcome of infants with progression to asymptomatic severe hydrocephalus did not differ from that of infants in whom disease progression was arrested. Poor outcome in infants with intraventricular hemorrhage and subsequent posthemorrhagic hydrocephalus was related to severity of hemorrhage and gestational age at birth less than 30 weeks. Because long-term outcome of infants with severe hydrocephalus did not differ from that of infants in whom the progression of hydrocephalus was arrested or whose condition improved before hydrocephalus became severe, we currently attempt medical management of these infants.