Neurodevelopmental Outcome of Preterm Infants with Severe Intraventricular Hemorrhage and Therapy for Post-Hemorrhagic Ventricular Dilatation

Brouwer, Annemieke J.; Groenendaal, Floris; Haastert, Inge-Lot van; Rademaker, Karin J; Hanlo, Patrick W.; Vries, Linda de

doi:10.1016/j.jpeds.2007.10.005

Cited by 181 publications

(126 citation statements)

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“…The predictive factors that can aid in the replacement of a temporary ventricular drainage method with a permanent one are not yet established 4,13,17 . In general, depending on the study sample, the percentage of patients depending on a permanent shunt in the follow-up period ranges from 30% to 75% 4,6,15 , in agreement with our findings that show 68% of our patients needing the permanent shunt.…”

Section: Discussionsupporting

confidence: 91%

“…A diagnosis of PHH secondary to IVH was made when the anterior horns width of the lateral ventricles was ≥ 6 mm as measured in the anterior coronal plane at the level of the septum pellucidum (median line), with the midpoint in the lateral wall of the lateral ventricle (at the level of caudate nucleus and the foramen of Monro) (Figure) 4,15,16 . Comorbidities considered as severe were global hypotonia associated to bradycardia, cardiorespiratory arrest, respiratory failure, cutaneous cyanosis, sepsis and other infections associated with clinical and laboratory worsening.…”

Section: Definitions Of Prematurity Ivh and Phhmentioning

confidence: 99%

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Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Melo¹,

Passos²,

Carvalho³

2017

Arq. Neuro-Psiquiatr.

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Objective: The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods: A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results: Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion: Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.Keywords: cerebral hemorrhage; hydrocephalus; cerebrospinal fluid. RESUMOObjetivo: A literatura descreve várias opções de drenagem liquórica (DL) para alivio da hidrocefalia pós-hemorrágica (HPH) em neonatos prematuros; contudo, não existe um consenso sobre a melhor abordagem. O escopo deste estudo foi descrever uma série de casos de neonatos prematuros, portadores de HPH, verificando os resultados de diferentes técnicas utilizadas para DL. Métodos: Revisão consecutiva dos prontuários de neonatos com diagnostico de HPH submetidos a DL. Resultados: Quarenta recém-nascidos prematuros foram incluídos. A punção lombar seriada (PL), a derivação ventriculosubgaleal (VSG) e a derivação ventrículo peritoneal (VP) foram o tratamento escolhido em 25%, 37,5% e 37,5% dos casos, respectivamente. Conclusão: As opções de DL devem ser avaliadas caso a caso, sendo dada preferência às drenagens temporária em prematuros com idade e peso mais baixos ao nascer, enquanto o shunt definitivo (derivação VP) pode ser considerado naqueles prematuros mais saudáveis, com idade e peso superiores.Palavras-chave: hemorragia cerebral; hidrocefalia; líquido cefalorraquidiano. Intraventricular hemorrhage (IVH) has been a major cause of mortality among premature neonates for more than 40 years 1,2 and is associated with neonatal encephalopathy, subsequent subtle apnea, and death 1,2,3,4 . Low birth-weight premature neonates are more vulnerable to IVH and, depending on the IVH grade, to posthemorrhagic hydrocephalus (PHH). Posthemorrhagic hydrocephalus can evolve to progressive PHH, and in more severe cases, to periventricular hemorrhagic infarct, hemorrhagic cerebral injury, and periventricular leukomalacia 1,4,5 . Between 15% to 20% of neonates born with a weight less than 1,500 g are estimated to develop IVH. Further, 75% of those with Papile grade III or IV hemorrhages develop progressive PHH and need a permanent shunt 4,6 .The literature does not clearly indicate any standardized protocols for the best PHH treatment o...

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Section: Discussionsupporting

confidence: 91%

Section: Definitions Of Prematurity Ivh and Phhmentioning

confidence: 99%

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Melo¹,

Passos²,

Carvalho³

2017

Arq. Neuro-Psiquiatr.

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“…Na análise univariada, identificou-se diferença entre os dois grupos para os seguintes achados clínicos: ciclo completo de corticosteroide pré-natal (57% nos casos vs. 80% nos controles; p=0,001; OR: 0,33; IC95% 0,17-0,64); sexo masculino (63% casos vs. 41% controles; p=0,004; OR: 2,45, IC95% 1,3-4,5); nascidos em outro hospital (26% casos vs. 9% controles; p=0,005; OR: 3,3 IC95% 1,4-8,0); Índice de Risco Clínico para Bebês acima de 5 (24% nos casos vs. 12% nos controles; p=0,029; OR: 2,4 IC95% 1,1-5,6); intubação na sala de parto (47% casos vs. 27% controles; p=0,007; OR: 2,38; IC95%: 1,3-4,5); e sepse neonatal (34% nos casos vs. 20% nos controlos; p=0,039; OR: 2,1 95% CI 1,03-4,1). Após a regressão logística, as diferenças foram mantidas apenas para o corticosteróide antenatal (p=0,005; OR 0,34, IC 95% 0,16-0,72) e sexo masculino (p=0,002; OR 2,9, IC95% 1, [4][5]8). Um déficit grave de neurodesenvolvimento esteve presente em três casos (3,5%) e um controle (1,2%).…”

Section: Introductionunclassified

“…Several studies have shown the negative impact of severe IVH on mortality and neurodevelopmental outcome of affected patients [8,9], but there is no agreement about the impact of low-grade IVH. Although data from large population studies suggest that preterm infants with IVH grades I and II are not at risk for longterm neurodevelopmental impairment [10,11], other studies indicate that this population is vulnerable to poor outcome [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Peixoto

Amaral

Resende

et al. 2018

Sci Med

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AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age. METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient <2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment. RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls. CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.KEYWORDS: cerebral intraventricular hemorrhage; preterm infant; neurodevelopmental disorders. RESUMOOBJETIVOS: Avaliar o impacto da hemorragia intraventricular de baixo grau no neurodesenvolvimento de lactentes prematuros aos 24 meses de idade. MÉTODOS: Foi conduzido um estudo de caso-controle retrospectivo em lactentes com idade gestacional inferior a 34 semanas, internados em uma Unidade de Terapia Intensiva Neonatal entre janeiro de 2006 e dezembro de 2015. Os casos foram definidos como aqueles com hemorragia intraventricular de baixo grau (graus I ou II), diagnosticada por ultrassonografia craniana. Para cada caso, foi selecionado um controle com a mesma idade gestacional, mas sem hemorragia intraventricular. A avaliação do neurodesenvolvimento foi realizada aos 24 meses de idade, em casos e controles, com a Escala de Desen...

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“…13,[15][16][17] In a large study of 214 infants with severe IVH, only 7.4% of those with Grade 3 and 49% with Grade 4 IVH had cerebral palsy and the majority had normal developmental quotients at 24 months. 15 Others have also attempted to elucidate features of IVH and/or comorbid conditions which negatively impact prognosis. In a multicenter analysis of 69 VLBW infants with PVHI, rates of moderate to severe cerebral palsy were 37 vs 88% and for MDIo70 were 36 vs 93% for infants with unilateral vs bilateral involvement, respectively at 18-36 months.…”

mentioning

confidence: 99%

Severe intraventricular hemorrhage in a new decade: what do we tell parents?

Patra

2014

J Perinatol

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Neurodevelopmental Outcome of Preterm Infants with Severe Intraventricular Hemorrhage and Therapy for Post-Hemorrhagic Ventricular Dilatation

Cited by 181 publications

References 27 publications

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Severe intraventricular hemorrhage in a new decade: what do we tell parents?

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