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Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
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Implementing early posthemorrhagic ventricular dilation intervention in preterm neonates: does a standardized pathway

Jennifer C Keene1, Betsy Ostrander1, Katherine Hartman1

  • 11Department of Pediatrics, Division of Child Neurology, University of Utah, Salt Lake City.

Journal of Neurosurgery. Pediatrics
|May 29, 2026
PubMed
Summary

A new standardized care pathway for posthemorrhagic ventricular dilation (PHVD) in preterm infants reduced ventricular size and improved neurodevelopmental outcomes, decreasing death or severe cerebral palsy by 29%.

Keywords:
hydrocephalusintraventricular hemorrhageneonatal neurologyposthemorrhagic ventricular dilation

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Area of Science:

  • Neonatal neurology
  • Pediatric neurosurgery
  • Developmental pediatrics

Background:

  • Posthemorrhagic ventricular dilation (PHVD) is a severe complication in extremely preterm infants following intraventricular hemorrhage.
  • PHVD is linked to significant rates of mortality and long-term neurodevelopmental deficits.
  • Current treatment practices for PHVD vary, with ongoing debate regarding optimal timing for cerebrospinal fluid (CSF) diversion.

Purpose of the Study:

  • To evaluate the impact of a standardized multidisciplinary treatment pathway for PHVD implemented in 2021.
  • To determine if the new pathway reduced ventricular dilation and improved neurodevelopmental outcomes in neonates with PHVD.
  • To assess the association between ventricular size and adverse outcomes.

Main Methods:

  • A single-center cohort study analyzed neonates with PHVD treated between 2017 and 2023.
  • Patients were divided into pre-pathway and post-pathway implementation groups.
  • Interventions included lumbar puncture (LP), ventricular reservoir, and ventriculoperitoneal shunt (VPS) placement, with ventricular size measured by anterior horn width (AHW) and ventricular index (VI).

Main Results:

  • The post-pathway group showed significantly lower median maximum anterior horn width (AHW) and ventricular index (VI) compared to the pre-pathway group (p=0.03 and p=0.04, respectively).
  • Among infants with 18-month follow-up, death or severe cerebral palsy decreased by 29% post-pathway implementation (62% vs. 33%, p=0.03).
  • Larger ventricular size independently predicted higher odds of death or severe cerebral palsy.

Conclusions:

  • A standardized care pathway for PHVD can potentially improve neurodevelopmental outcomes in extremely preterm infants.
  • Pathway implementation led to reduced ventricular size, and smaller ventricular size is a strong predictor of better neurodevelopmental outcomes.
  • Findings support earlier, standardized interventions for PHVD and suggest the need for multicenter validation.