Posthemorrhagic hydrocephalus in high-risk preterm infants: Natural history, management, and long-term outcome

Dykes, Francine D.; Dunbar, Barbara; Lazarra, Anthony; Ahmann, Peter A.

doi:10.1016/s0022-3476(89)80707-3

Cited by 83 publications

(55 citation statements)

References 17 publications

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“…Hydrocephalus can develop by spread of blood through the ventricular system with CSF circulation impaired at various stages from physical obstruction at the foramen of Munro to the toxic effects of blood breakdown products at the arachnoid granulations. The higher pressure can cause cerebral white matter injury by ischemia, altered energy metabolism and demyelination [16,37,38,39]. The association between severity of IVH and the likelihood of developing hydrocephalus among our patients has been consistently described by other studies [18, 40, 41].…”

Section: Discussionsupporting

confidence: 57%

“…Mortality associated with IVH depends on severity, with rates that range from 5 to 50% for patients with grade I and grade IV hemorrhages, respectively [15]. Neurological morbidity among these patients reportedly includes cerebral palsy, cognitive disability, neurological deficit and hydrocephalus [16,17,18], though the condition of prematurity likely further exacerbates each of these. A recent decrease in IVH-related complications has been observed despite an increase in the survival of very-low-birth-weight infants, which may be attributed to earlier diagnosis and more targeted intervention, an example of which is prophylactic indomethacin that reduces the incidence of severe IVH [6, 19].…”

Section: Introductionmentioning

confidence: 99%

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Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

et al. 2009

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Objective: This work evaluated the mortality and functional outcomes of premature infants sustaining intraventricular hemorrhage (IVH). These outcomes were analyzed for their association with IVH severity, development of hydrocephalus and need for ventriculoperitoneal (VP) shunt insertion. Methods: A retrospective review was performed of neonates at the Children’s Hospital of Eastern Ontario who sustained IVH (1989–2005). Logistic regression tested demographic predictors of IVH severity, development of hydrocephalus and mortality. χ² analysis differentiated functional outcomes and mortality by IVH grade, development of hydrocephalus and intervention for cerebrospinal fluid diversion. All analyses used the 0.05 significance level. Results: Data were available for 284 patients with an average follow-up of 5.1 years. These were distributed as grade I (n = 135), grade II (n = 52), grade III (n = 43) and grade IV (n = 54), with lower gestational age and birth weight predicting disease severity. Hydrocephalus developed in 21% of patients, of whom 39% required VP shunt insertion. Overall mortality of 20% depended on IVH grade and was highest for grade IV patients (59%). Functional independence diminished with IVH severity, and patients with hydrocephalus fared worse than those without this sequel. Outcomes of patients developing hydrocephalus were similar whether or not they eventually required VP shunt insertion. Conclusions: This study describes a large cohort of neonatal IVH, describing how disease severity affects mortality and functional outcome. The overall mortality of nearly 1 in 5 patients is primarily of grade IV patients, with no difference between grade II and grade III. Further, patients surviving their hydrocephalus exhibited no worse functional deterioration if they required surgical intervention.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

et al. 2009

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“…Very low birth weight infants are at high risk of developing IVH (1). PHH is a major complication of IVH and contributes importantly to subsequent long-term cognitive and motor disability (2)(3)(4)(5). The management of infants with PHH is controversial because the benefits of any specific treatment regimen have not been established (2,(5)(6)(7)(8).…”

mentioning

confidence: 99%

“…PHH is a major complication of IVH and contributes importantly to subsequent long-term cognitive and motor disability (2)(3)(4)(5). The management of infants with PHH is controversial because the benefits of any specific treatment regimen have not been established (2,(5)(6)(7)(8). However, substantial data from experimental animal studies of hydrocephalus suggest that impairments in cerebral hemodynamics and oxidative metabolism play a significant role in the pathophysiology of brain injury associated with this disorder (1).…”

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confidence: 99%

CSF Removal in Infantile Posthemorrhagic Hydrocephalus Results in Significant Improvement in Cerebral Hemodynamics

et al. 2004

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“…[1][2][3][4][5][6] Serial lumbar punctures and pharmacological agents such as acetazolamide and furosemide have been tried as treatment modalities to reduce intracranial pressure but the optimal management remains controversial. [7][8][9] Insertion of intraventricular reservoir (IVR) is frequently used as a temporary measure for drainage of cerebrospinal fluid (CSF) in infants with PHVD.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of cerebrospinal fluid parameters in preterm infants with intraventricular reservoirs

2012

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Objective: Intraventricular reservoirs (IVRs) are used to drain cerebrospinal fluid (CSF) in neonates with post-hemorrhagic ventricular dilatation (PHVD). The objectives of this case-control study were to evaluate changes in CSF parameters in serial IVR taps and to compare CSF parameters in culture-positive and -negative specimens.Study Design: Clinical and laboratory data from serial (up to 7) reservoir taps at 5-to 8-day intervals were collected on preterm neonates with PHVD and IVR insertion. Result:The median (range) gestational age and birth weight of our cohort (n ¼ 52) was 26 (23 to 33) weeks and 796 (450 to 1620) grams. Significant decreases in percentage of CSF neutrophils and protein were noted in later taps, compared with the first tap at insertion of IVR. Five (9.6%) infants had positive CSF cultures on 10 occasions. Compared with negative specimens (n ¼ 266), the mean (s.d.) proportion of neutrophils in CSF (55% (33) vs 26% (23)) was significantly higher and ratio of CSF to serum glucose significantly lower (0.19 (0.08) vs 0.29 (0.13)) in culture-positive specimens (n ¼ 10). The area under the curve was 0.82 (95% confidence interval (CI) 0.72 to 0.93) for CSF white blood cell (WBC) count, 0.79 (95% CI 0.68 to 0.90) for CSF protein and 0.75 (95% CI 0.56 to 0.95) for percentage of neutrophils. The sensitivities and specificities for diagnosis of infection was 90 and 63% for CSF WBC count > 42 mm -3 , 89 and 58% for CSF protein at > 250mg dl -1 and 80 and 67% for CSF neutrophil proportion >31.5%.Conclusion: CSF parameters from IVR taps, specifically proportion of neutrophils and proteins are higher at insertion and progressively normalize over time. Although they vary widely, CSF WBC, protein and neutrophil proportion using higher cut-off values have good sensitivity in the diagnosis of infection.

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Posthemorrhagic hydrocephalus in high-risk preterm infants: Natural history, management, and long-term outcome

Cited by 83 publications

References 17 publications

Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

CSF Removal in Infantile Posthemorrhagic Hydrocephalus Results in Significant Improvement in Cerebral Hemodynamics

Evaluation of cerebrospinal fluid parameters in preterm infants with intraventricular reservoirs

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