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Updated: May 11, 2026
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Published on: March 14, 2013
Integrating Clinical and Neuroimaging Markers to Predict the Onset of Posthemorrhagic Ventricular Dilatation in
Abdul Aziz Al-Garni1, Avneet Mazara2, Nina Stein3
1Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Insights
Early detection of risk factors like significant patent ductus arteriosus and sepsis in preterm infants can help predict posthemorrhagic ventricular dilatation (PHVD) and its severe outcomes.
Area of Science:
- Neonatal neurology
- Pediatric neurosurgery
- Perinatal medicine
Background:
- Posthemorrhagic ventricular dilatation (PHVD) is a serious complication of intraventricular hemorrhage (IVH) in premature infants.
- PHVD significantly increases the risk of cerebral palsy and cognitive deficits.
Purpose of the Study:
- To identify early perinatal risk factors associated with the development of progressive PHVD.
- To improve prediction and management of PHVD in high-risk neonates.
Main Methods:
- Retrospective review of neonates (≤29 weeks GA) with Grade II-III IVH and PVHI (2015-2021).
- Cranial ultrasounds within 14 days postnatal age (PNA) assessed for IVH grade, AHW, VI, and TOD.
- Outcome defined as death or moderate-risk zone VI/AHW/TOD beyond 2 weeks PNA.
Main Results:
- Of 146 infants, 39% developed PHVD; 30% required ventricular reservoir and 20% needed shunt insertion.
- Significant risk factors within 14 days PNA included hemodynamically significant PDA (OR 6.1), sepsis (OR 5.4), Grade III IVH (OR 4.6), PVHI (OR 3.0), and VI (OR 2.1).
Conclusions:
- Hemodynamically significant PDA and bacterial septicemia are key clinical predictors of PHVD.
- Early cranial ultrasound measurements of AHW and VI can predict the subsequent onset of PHVD.
Background:
Posthemorrhagic ventricular dilatation (PHVD) is a major complication of intraventricular hemorrhage (IVH); it is associated with high risks of cerebral palsy and cognitive deficits compared with infants without PHVD. This study aims to explore the early perinatal risk factors-associated with the risk of progressive PHVD.
Methods:
Neonates ≤29 weeks gestational age (GA) with Grade II-III IVH and periventricular hemorrhagic infarct (PVHI) between 2015 and 2021 were retrospectively reviewed. All cranial ultrasounds done within 14 days postnatal age (PNA) were assessed for grade of IVH, anterior horn width (AHW), ventricular index (VI), and thalamo-occipital index (TOD). The outcome was defined as death of any cause or VI and/or AHW and/or TOD ≥ moderate-risk zone based on an ultrasound done beyond two weeks PNA.
Results:
A total of 146 infants with a mean GA of 26 ± 1.8 weeks, birth weight 900 ± 234 g were included, 46% were females. The primary outcome occurred in 56 (39%) infants; among them 17 (30%) and 11 (20%) needed ventricular reservoir and shunt insertion, respectively. The risk factors present within 14 days PNA that significantly increased the odds of developing PHVD were hemodynamically significant patent ductus arteriosus (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.9 to 22), culture-proven sepsis (OR 5.4, 95% CI 1.8 to 18), Grade III IVH (OR 4.6, 95% CI 1.1 to 22), PVHI (OR 3.0, 95% CI 0.9 to 10), and VI (OR 2.1, 95% CI 1.6 to 2.9).
Conclusions:
Clinical predictors such as significant ductus arteriosus and bacterial septicemia, along with risk levels of AHW and VI measured with early cranial ultrasounds, are potential predictors of subsequent onset of PHVD.
