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Outcomes Following Post-Hemorrhagic Ventricular Dilatation among Infants of Extremely Low Gestational Age
Seetha Shankaran1, Monika Bajaj1, Girija Natarajan1
1Department of Pediatrics, Wayne State University, Detroit, MI.
Insights
Post-hemorrhagic ventricular dilatation (PHVD) significantly increases death or impairment risk in preterm infants born at 26 weeks or less. Intervention for progressive PHVD further elevates this risk, underscoring the need for careful management.
Area of Science:
- Neonatology
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Post-hemorrhagic ventricular dilatation (PHVD) is a serious complication in extremely preterm infants.
- Understanding the neurodevelopmental outcomes associated with PHVD is crucial for clinical management.
Purpose of the Study:
- To assess outcomes in infants born at or before 26 weeks of gestation with PHVD.
- To compare outcomes between infants with PHVD, intracranial hemorrhage without ventricular dilatation, and normal head ultrasound.
Main Methods:
- An observational study included 4216 infants born between 2011 and 2015.
- Infants were categorized by head ultrasound findings: PHVD, hemorrhage without dilatation, or normal.
- Neurodevelopmental impairment was assessed at 18-26 months, and multivariable logistic regression was used to analyze outcomes.
Main Results:
- Infants with PHVD had significantly higher rates of death or neurodevelopmental impairment (68%) compared to those with hemorrhage without dilatation (39%) and normal ultrasound (28%).
- Intervention for progressive PHVD was associated with increased risk of death or impairment (80% vs. 65%).
- Factors associated with increased risk included PHVD, intervention for PHVD, male sex, and retinopathy surgery; increased gestational age was protective.
Conclusions:
- PHVD is linked to substantial death and impairment rates in extremely preterm infants.
- Progressive PHVD requiring intervention further elevates these risks.
- Gestational age and specific interventions significantly impact outcomes.
Objective:
To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation.
Study Design:
Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score <70, blindness, or deafness. Multivariable logistic regression examined the association of death or impairment, adjusting for neonatal course, center, maternal education, and parenchymal hemorrhage.
Results:
Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week.
Conclusions:
PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.
