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Post-haemorrhagic hydrocephalus management: Delayed neonatal transport negatively affects outcome
Alessandro Parodi1, Ilaria Giordano1, Laura De Angelis1
1Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Insights
Outborn infants transferred for post-haemorrhagic ventricular dilatation (PHVD) treatment experienced more severe brain swelling and higher rates of developmental delay. Early transfer to specialized centers is crucial for better outcomes in premature infants with PHVD.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Developmental Pediatrics
Background:
- Post-haemorrhagic ventricular dilatation (PHVD) is a significant cause of brain injury in premature infants.
- Intervention is typically recommended when the Ventricular Index (VI) exceeds the 97th percentile + 4 mm (Levene criteria).
Purpose of the Study:
- To compare PHVD severity, intervention timing, and outcomes between outborn infants transferred for treatment and inborn infants.
- To evaluate neurodevelopmental outcomes in relation to transfer status.
Main Methods:
- Retrospective comparison of outborn and inborn preterm infants with PHVD requiring treatment.
- Analysis of age at intervention, Ventricular Index percentile difference (VI-p97), permanent shunt rate, and developmental delay rate.
- Neurodevelopmental assessment using the Vineland Adaptive Behavior Scales II (VABS-II) at 5 years, defining developmental delay as a score <70.
Main Results:
- Outborn infants presented with significantly higher VI-p97 values, indicating more severe ventricular dilatation.
- While not statistically significant (p=0.18), outborn infants had a higher rate of permanent shunt insertion (66.7% vs 40.0%).
- After excluding infants with parenchymal lesions, outborn infants showed a significantly higher rate of developmental delay at 5 years (66.7% vs 18.2%, p=0.04).
Conclusions:
- Outborn infants exhibited more severe PHVD and a trend towards worse outcomes, including higher rates of permanent shunting and developmental delay.
- Timely transfer to specialized centers with expertise in PHVD management is recommended for optimal infant care.
Background:
Post-haemorrhagic ventricular dilatation (PHVD) still represents an important cause of brain injury in premature infants. Intervention for PHVD is recommended once Ventricular Index (VI) crosses the 97th percentile + 4 mm line according to Levene.
Objectives:
We aimed to compare PHVD severity, timing of intervention, and outcome between outborn infants transferred to a level IV NICU in order to be treated for PHVD and a control population of inborn infants.
Methods:
Preterm infants with PHVD requiring treatment were divided into: outborn infants (transferred to our NICU in order to be treated for PHVD) and inborn infants (PHVD diagnosed at our NICU). Age at intervention, difference between VI and the 97th percentile according to postmenstrual age (VI-p97), permanent shunt rate, and developmental delay rate were compared between the two groups. Neurodevelopmental outcome was assessed using the Vineland Adaptive Behavior Scales II (VABS-II), a parental questionnaire investigating four domains of adaptive behaviour and overall adaptive functioning. Developmental delay was defined as a score <70 (-2 SD or less).
Results:
Twelve outborn and 15 inborn infants were included. Age at intervention (31.6 vs 17.4 days) and VI-p97 (left 10.0 vs 5.1 mm, right 7.7 vs 5.1 mm) were significantly higher among outborn infants. A permanent shunt was inserted in 66.7% of outborn and in 40.0% of inborn infants (p = 0.18). After excluding subjects with parenchymal lesions, a significantly higher rate of developmental delay was observed at 5 years in outborn patients compared to inborn patients (66.7% of outborn vs 18.2% of inborn patients with VABS-II composite score <70, p = 0.04).
Conclusions:
Outborn infants reached a significantly more severe ventricular dilatation than inborn infants, largely exceeding the recommended cutoff for intervention. Our follow-up data showed a trend towards a higher rate of permanent shunt and developmental delay in outborn than in inborn patients. Infants requiring treatment should be timely transported to centres with adequate expertise in PHVD management.
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