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Intraventricular Hemorrhage in Premature Infants: A Historical Review
Jennifer Deger1, Eric A Goethe1, Melissa A LoPresti1
1Department of Neurosurgery, Baylor College of Medicine, Division of Neurosurgery, Texas Children's Hospital, Houston, Texas.
Insights
Intraventricular hemorrhage (IVH) in premature infants is common and causes lifelong disability. This review traces the historical evolution of IVH management, highlighting ongoing challenges despite treatment advances.
Area of Science:
- Neonatal Medicine
- Pediatric Neurosurgery
- Medical History
Background:
- Intraventricular hemorrhage (IVH) is a frequent complication in premature newborns.
- IVH significantly increases the risk of long-term morbidity and lifelong disability.
Purpose of the Study:
- To review the historical evolution of intraventricular hemorrhage (IVH) management in newborns.
- To examine changes in the epidemiology, pathogenesis, and treatment of IVH over time.
Main Methods:
- Comprehensive literature search for original and secondary research on IVH.
- Historical review of medical and surgical treatment strategies for IVH in preterm infants.
Main Results:
- Early medical management focused on coagulopathy and perinatal instability.
- Surgical interventions evolved from lumbar punctures to shunting and clot burden management.
- Despite advancements, IVH remains a significant cause of morbidity and mortality.
Conclusions:
- The management of IVH has evolved considerably over the past century.
- IVH continues to impact patient quality of life and healthcare costs.
- Understanding historical approaches may guide future IVH treatment development.
Abstract:
Intraventricular hemorrhage (IVH) is common in premature newborns and poses a high risk for morbidity with lifelong disability. We searched the available literature for original and secondary literature regarding the epidemiology, pathogenesis, and treatment of IVH in order to trace changes in the management of this disease over time. We examined IVH pathogenesis and epidemiology and reviewed the history of medical and surgical treatment for intraventricular hemorrhage in preterm children. Initial medical management strategies aimed at correcting coagulopathy and eventually targeted mediators of perinatal instability including respiratory distress. Surgical management centered around cerebrospinal fluid diversion, initially through serial lumbar punctures, progressing to ventriculoperitoneal shunting, with more recent interventions addressing intraventricular clot burden. We provide a historical review of the evolution of treatment for IVH in newborns. While the management of IVH has grown significantly over time, IVH remains a common neurosurgical disease that continues to affect patient and caregiver quality of life and health care costs. Despite advances in treatment over more than a century, IVH remains a significant cause of morbidity and mortality in premature infants, and an understanding of past approaches may inform the development of new treatments.
