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Posthemorrhagic hydrocephalus. Low incidence in very low birth weight neonates with intraventricular hemorrhage
Insights
Posthemorrhagic hydrocephalus (PHH) affects preterm infants with intraventricular hemorrhage (IVH). This study found a low incidence of PHH requiring intervention in neonates with germinal matrix/intraventricular hemorrhage (GMH/IVH).
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Developmental Pediatrics
Background:
- Infants with intraventricular hemorrhage (IVH) face risks including seizures and neurodevelopmental issues.
- Posthemorrhagic hydrocephalus (PHH) is a significant complication of IVH, with reported incidence in preterm infants ranging from 25% to 74%.
Purpose of the Study:
- To investigate the incidence of posthemorrhagic hydrocephalus (PHH) in neonates with germinal matrix/intraventricular hemorrhage (GMH/IVH).
- To evaluate the development of ventriculomegaly and the need for intervention in this high-risk population.
Main Methods:
- A cohort of 438 neonates weighing 1250-gm or less was studied over 46 months.
- Computerized tomography and/or cranial ultrasound were used to diagnose GMH/IVH in 265 survivors.
- Serial investigations monitored for ventriculomegaly and PHH in 52 infants with confirmed IVH.
Main Results:
- Of 133 infants with GMH/IVH, 95 survived. Only 5 of the 52 survivors with IVH developed PHH requiring intervention.
- Serial ultrasound in 95 other infants showed similar rates of low-pressure ventriculomegaly in hemorrhage and non-hemorrhage groups, with no shunting required.
- One infant with congenital aqueductal stenosis was also identified.
Conclusions:
- The incidence of clinically significant PHH requiring intervention in neonates with GMH/IVH appears lower than previously reported.
- Routine serial ultrasound may detect ventriculomegaly, but intervention for PHH is infrequent in this cohort.
- Further research is needed to refine management strategies for GMH/IVH and associated hydrocephalus.
Abstract:
In addition to seizures and long-term neurodevelopmental handicaps, infants with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus (PHH), and the incidence of this problem in preterm infants with known IVH has been reported to vary from 25% to 74%. Over a 46-month period, 438 neonates of 1250-gm birth weight or less were admitted to this Newborn Special Care Unit, and 269 survived the first 36 postnatal hours. Of these, 265 patients underwent computerized tomography and/or cranial ultrasound scanning for evaluation of germinal matrix and/or intraventricular hemorrhage (GMH/IVH): 133 infants were found to have experienced GMH/IVH, and 27 of these died within the 1st postnatal week. Of the 95 survivors with GMH/IVH, 43 were known to have GMH only; the other 52 experienced IVH and were therefore at risk for PHH. Patients with GMH/IVH underwent repeat investigations for the development of ventriculomegaly and possible PHH. Only five patients with IVH developed PHH, defined as ventriculomegaly, elevated intracranial pressure, and increasing occipitofrontal head circumference. Serial cranial ultrasound studies of 95 other consecutively admitted patients in this birth-weight range revealed an equal incidence (45%) of low intracranial pressure ventriculomegaly in both the hemorrhage and non-hemorrhage groups, but none of them required shunting for hydrocephalus. One infant with congenital aqueductal stenosis was also identified.