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Implementation of an early intervention strategy for post hemorrhagic ventricular dilatation in preterm infants
Diane Wilson1, Sara Breitbart2, Lee DiFonzo3
1Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. diane.wilson@sickkids.ca.
Insights
Early intervention for post-hemorrhagic ventricular dilatation (PHVD) in preterm infants is feasible. This approach improved neurodevelopmental outcomes compared to delayed treatment, offering better results for infants born at or before 32 weeks
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Developmental Pediatrics
Background:
- Post-hemorrhagic ventricular dilatation (PHVD) is a serious complication in preterm infants.
- Optimal timing for PHVD intervention remains debated.
- Current management strategies vary, impacting infant outcomes.
Purpose of the Study:
- To evaluate the impact of earlier intervention on short- and longer-term outcomes in preterm infants with PHVD.
- To compare neurodevelopmental outcomes between early and late intervention groups.
- To assess the feasibility of initiating early PHVD management.
Main Methods:
- Retrospective, multi-center, observational study.
- Included preterm infants (≤32 weeks' gestation) with PHVD.
- Analyzed intervention strategies: lumbar puncture (LP), ventricular access device (VAD), and shunting.
Main Results:
- Of 70 survivors, 46% had spontaneous PHVD resolution.
- 38 infants required intervention, utilizing LP, VAD, or shunting.
- Early intervention, initiated at smaller ventricle size, showed improved Bayley Scales of Infant and Toddler Development (BSID-III) scores compared to a historical late-intervention cohort.
Conclusions:
- Early intervention for PHVD in preterm infants is feasible.
- Initiating intervention earlier is associated with improved neurodevelopmental outcomes.
- This approach offers a potential advantage over delayed treatment strategies.
Objective:
Evaluate earlier intervention on short- and longer-term outcomes in preterm infants with post-hemorrhagic ventricular dilatation (PHVD) born at ≤32 weeks' gestation.
Study Design:
Retrospective, multi-center, observational study.
Results:
One hundred patients met eligibility criteria. Of 70 survivors, PHVD resolved spontaneously in 32 (46%). The 38 infants needing intervention were managed with: lumbar puncture (LP) alone (n = 23, 60%); LP and ventricular access device (VAD) only (n = 6, 16%); LP, VAD, ventricular-peritoneal shunt (n = 9, 24%). There were no differences in incidence of cerebral palsy or Bayley Scales of Infant and Toddler Development (BSID-III) composite score between the intervention and non-intervention group (p > 0.5). Neurosurgical intervention was initiated at smaller ventricle size and BSID-III scores improved significantly compared to a historical cohort with late intervention, (p < 0.05).
Conclusion:
Initiation of early intervention for PHVD was feasible and was associated with improved neurodevelopmental outcomes compared to late intervention.
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