Post hemorrhagic hydrocephalus and neurodevelopmental outcomes in a context of neonatal intraventricular hemorrhage: an institutional experience in 122 preterm children

Abstract

BackgroundIntraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births. Despite a high risk of death and impaired neurodevelopment, the precise prognosis of infants with IVH remains unclear. The objective of this study was to evaluate the rate and predictive factors of evolution to post hemorrhagic hydrocephalus (PHH) requiring a shunt, in newborns with IVH and to report their neurodevelopmental outcomes at 2 years of age.MethodsAmong all preterm newborns admitted to the department of neonatalogy at Rouen University Hospital, France between January 2000 and December 2013, 122 had an IVH and were included in the study. Newborns with grade 1 IVH according to the Papile classification were excluded.ResultsAt 2-year, 18% (n = 22) of our IVH cohort required permanent cerebro spinal fluid (CSF) derivation. High IVH grade, low gestational age at birth and increased head circumference were risk factors for PHH. The rate of death of IVH was 36.9% (n = 45). The rate of cerebral palsy was 55.9% (n = 43) in the 77 surviving patients (49.4%). Risk factors for impaired neurodevelopment were high grade IVH and increased head circumference.ConclusionHigh IVH grade was strongly correlated with death and neurodevelopmental outcome. The impact of an increased head circumference highlights the need for early management. CSF biomarkers and new medical treatments such as antenatal magnesium sulfate have emerged and could predict and improve the prognosis of these newborns with PHH.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1249-x) contains supplementary material, which is available to authorized users.

Epilepsy occurrence after neonatal morbidities in very preterm infants

“…In a report by Strober et al, six of 61 (9.8%) preterm infants with IVH (grade III or IV) presented remote seizures (defined as epileptic seizures) after the first month . In another report by Gilard et al, three of 77 (3.9%) preterm infants with IVH presented with epilepsy at the age of 2 years . In the current study, the incidence of epilepsy was 21% at 5 years in preterm children with high‐grade IVH, and only 1% in those with low‐grade IVH (grade I/II).…”

“…24 In another report by Gilard et al, three of 77 (3.9%) preterm infants with IVH presented with epilepsy at the age of 2 years. 25 In the current study, the incidence of epilepsy was 21% at 5 years in preterm children with high-grade IVH, and only 1% in those with low-grade IVH (grade I/II). IVH is usually initiated in the germinal matrix, a highly vascularized collection of glial and neuronal precursor cells located on the head of the caudate nucleus.…”

Intraventricular Hemorrhage in Very Preterm Infants: A Comprehensive Review

“…Moreover, the shunt exposes this group of children to increased morbidity and mortality due to the risk of a shunt dysfunction and recurrent surgery exposition [5,63]. The rate of death and cerebral palsy in older children is correlated with the grading of GMH-IVH-IPH, gestational age and weight at birth and the associated complications of preterm birth [13]. Due to the high risk of complications in preterm children with GMH-IVH-IPH, their early detection is mandatory to enable appropriate neuroprotective management.…”

“…Nevertheless, in cases of severe GMH-IVH-IPH, 40% of the preterm infants die from a neurological cause [5]. The association of prematurity, GMH-IVH-IPH and PHH is a strong determinant of impaired neurodevelopmental outcomes [12][13][14]. In the last 10 years, the incidence of preterm children with GMH-IVH-IPH has increased, likely due to the increased survival of extremely preterm children [5].…”

Validity of SyMRI for Assessment of the Neonatal Brain

“…As described in the literature, various types of brain damage that can occur in the neonatal period may severely affect further neurodevelopment [2,[31][32][33][34]. There is evidence that hemorrhage, hypoxic ischemic encephalopathy, and infarction are primarily among the most common causes of neonatal morbidity and mortality [35,36].…”