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Ventricular dilation after neonatal periventricular-intraventricular hemorrhage. Natural history and therapeutic
Insights
Late ventricular dilation in infants after periventricular-intraventricular hemorrhage (PV-IVH) often stabilizes or resolves spontaneously. Clinical symptoms, not just ventricular size, are crucial for determining treatment needs for hydrocephalus.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Medical Imaging in Pediatrics
Background:
- Periventricular-intraventricular hemorrhage (PV-IVH) is a common complication in preterm infants.
- Late ventricular dilation can occur after PV-IVH, potentially leading to hydrocephalus.
- Understanding the natural history of this dilation is critical for appropriate management.
Purpose of the Study:
- To define the natural history of late ventricular dilation following PV-IVH.
- To differentiate between posthemorrhagic hydrocephalus (PHH) and ventriculomegaly (VM).
- To identify factors influencing the progression of ventricular dilation.
Main Methods:
- Weekly ultrasound sector scans were used to monitor infants with PV-IVH.
- Infants were classified into groups based on the rate of ventricular dilation and clinical signs.
- Correlation between hemorrhage severity and ventricular size was analyzed.
Main Results:
- Late ventricular dilation developed in 26 of 48 at-risk infants.
- Of these, 14 had ventriculomegaly (VM) and 12 had posthemorrhagic hydrocephalus (PHH).
- Spontaneous stabilization or resolution of late ventricular dilation occurred in 54% of cases, with only three infants requiring a shunt.
Conclusions:
- Late ventricular dilation after PV-IVH has a variable natural history, with a significant proportion stabilizing or resolving spontaneously.
- Posthemorrhagic hydrocephalus is directly related to hemorrhage severity and characterized by larger lateral ventricle diameters.
- Clinical assessment alongside ventricular size is essential for guiding treatment decisions in infants with PV-IVH-associated ventricular dilation.
Abstract:
Infants with periventricular-intraventricular hemorrhage (PV-IVH) were followed up with weekly ultrasound sector scans to define the natural history of late ventricular dilation (ie, dilation in excess of that seen at the time of diagnosis of PV-IVH). Infants fell into two groups: (1) posthemorrhagic hydrocephalus (PHH), dilation that produced an increase in occipitofrontal circumference greater than 2 cm per week and/or clinical symptoms of increased intracranial pressure; and (2) ventriculomegaly (VM), dilation that stabilized or reversed without producing these effects. The former was directly related to the severity of hemorrhage. The diameter of the lateral ventricle was significantly greater in PHH. In 26 of 48 infants at risk, late dilation developed: 14 had VM and 12 had PHH. Thus, late ventricular dilation stabilized or resolved spontaneously in 54%. Only three infants eventually required a ventriculoperitoneal shunt. Clinical changes in addition to ventricular size should be used in assessing the need for treatment of ventricular dilation after PV-IVH.