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External ventricular drainage for posthemorrhagic ventricular dilatation in preterm infants: insights on efficacy and
Laura C De Angelis1,2, Alessandro Parodi1,2, Marianna Sebastiani1,2
11Department Mother and Child, Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa.
Insights
External ventricular drainage is effective for preterm infants with posthemorrhagic hydrocephalus. Lower gestational age increases the risk of needing a permanent shunt, despite current imaging limitations in prediction.
Area of Science:
- Neonatalogy
- Pediatric Neurosurgery
- Neuroradiology
Background:
- Posthemorrhagic ventricular dilatation is a common complication in preterm infants.
- External ventricular drain (EVD) insertion is a temporary measure to manage this condition.
- Predicting the need for permanent shunt dependency after EVD is crucial for optimal patient management.
Purpose of the Study:
- To characterize the clinical and neuroradiological features of preterm infants treated with EVD for posthemorrhagic ventricular dilatation.
- To identify factors associated with permanent shunt dependency in this cohort.
Main Methods:
- Retrospective review of medical records of preterm infants who underwent EVD insertion between 2012 and 2018.
- Analysis of clinical data and magnetic resonance imaging (MRI) including diffusion- and susceptibility-weighted imaging.
- Comparison of characteristics between infants who did and did not require permanent shunts.
Main Results:
- Of 28 infants, 53.6% required a permanent ventriculoperitoneal shunt.
- Lower gestational age was significantly associated with shunt dependency (p=0.035).
- Higher ventricular parameters and intraventricular hemorrhage scores were observed in the shunt-dependent group before EVD removal.
Conclusions:
- EVD is a reliable initial treatment for posthemorrhagic hydrocephalus in preterm infants.
- Lower gestational age is a key risk factor for progression to permanent shunt dependency.
- Current advanced MRI techniques do not fully predict the need for permanent cerebrospinal fluid diversion.
Objective:
The objective of this study was to describe the clinical and neuroradiological characteristics of a cohort of preterm infants who had undergone external ventricular drain insertion as a temporary measure to treat posthemorrhagic ventricular dilatation. In addition, the authors investigated the factors predicting permanent shunt dependency.
Methods:
The authors retrospectively reviewed the medical records of a cohort of preterm infants who had undergone external ventricular drain insertion at Gaslini Children's Hospital (Genoa, Italy) between March 2012 and February 2018. They also analyzed clinical characteristics and magnetic resonance imaging data, including diffusion- and susceptibility-weighted imaging studies, which were obtained before both catheter insertion and removal.
Results:
Twenty-eight infants were included in the study. The mean gestational age was 28.2 ± 2.7 weeks, and the mean birth weight was 1209 ± 476 g. A permanent ventriculoperitoneal shunt was inserted in 15/28 (53.6%) infants because of the failure of external ventricular drainage as a temporary treatment option. Compared with the shunt-free group, the shunt-dependent group had a significantly lower gestational age (29.3 ± 2.3 vs 27.2 ± 2.7 weeks, p = 0.035) and tended toward a lower birth weight (p = 0.056). None of the clinical and neuroradiological characteristics significantly differed between the shunt-free and shunt-dependent groups at the time of catheter insertion. As expected, ventricular parameters as well as the intraventricular extension of intracerebral hemorrhage, as assessed using the intraventricular hemorrhage score, were reportedly higher in the shunt-dependent group than in the shunt-free group before catheter removal.
Conclusions:
External ventricular drainage is a reliable first-line treatment for posthemorrhagic hydrocephalus. However, predicting its efficacy as a unique treatment remains challenging. A lower gestational age is associated with a higher risk of posthemorrhagic hydrocephalus progression, suggesting that the more undeveloped the mechanisms for the clearance of blood degradation products, the greater the risk of requiring permanent cerebrospinal fluid diversion, although sophisticated MRI investigations are currently unable to corroborate this hypothesis.
