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Posthemorrhagic ventricular dilatation late intervention threshold and associated brain injury

Eva Valverde1,2,3, Marta Ybarra1, Andrea V Benito1

  • 1Department of Neonatology, La Paz University Hospital, Madrid, Spain.

Plos One
|October 27, 2022
PubMed

Insights

A high-threshold intervention for posthemorrhagic ventricular dilatation (PHVD) in preterm infants is linked to increased white matter injury (WMI). This suggests a potential risk associated with aggressive management strategies in vulnerable newborns.

Area of Science:

  • Neonatal Neurology
  • Pediatric Neuroimaging
  • Perinatal Medicine

Background:

  • Posthemorrhagic ventricular dilatation (PHVD) is a common complication in preterm infants following germinal matrix-intraventricular hemorrhage.
  • White matter injury (WMI) is a significant cause of long-term neurodevelopmental deficits in preterm infants.
  • The optimal management strategy for PHVD remains debated, with varying approaches to intervention.

Purpose of the Study:

  • To systematically evaluate the association between a high-threshold intervention strategy for PHVD and the incidence and severity of WMI in preterm infants.
  • To compare WMI in preterm infants with PHVD managed with a high-threshold intervention versus a conservative approach.

Main Methods:

  • Retrospective analysis of 85 preterm infants (≤34 weeks gestation) with germinal matrix-intraventricular hemorrhage.
  • Assessment of cranial ultrasound (cUS) scans for WMI, ventricular width, and shape.
  • Comparison of WMI and ventricular parameters between an intervention group (cerebrospinal fluid drainage) and a non-intervention group.

Main Results:

  • Infants undergoing high-threshold intervention for PHVD exhibited significantly larger ventricular measurements compared to the non-intervention group.
  • Moderate and severe WMI were more prevalent in infants with PHVD, irrespective of the management strategy.
  • A direct linear correlation was observed between the severity of PHVD and the extent of WMI.

Conclusions:

  • A high-threshold intervention strategy for PHVD in preterm infants is associated with an increased risk of white matter injury.
  • The findings suggest that aggressive management of PHVD may exacerbate or be linked to more severe WMI.
  • Further research is warranted to refine management protocols for PHVD to minimize neurological sequelae in preterm infants.
Abstract

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