Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands

• Published in: Acta Paediatrica 2002-02, Vol.91 (2), p.212-217
• Main Authors: de Vries, LS, Liem, KD, van Dijk, K, Smit, BJ, Sie, L, Rademaker, KJ, Gavilanes, AWD
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cerebral Hemorrhage - pathology; Cerebral Hemorrhage - surgery; Cerebral Ventricles - pathology; Delivery. Postpartum. Lactation; Dilatation; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Hydrocephalus; Infant, Newborn; Infant, Premature, Diseases - surgery; Intensive care medicine; Intensive Care Units, Neonatal; intraventricular haemorrhage; Maternal, fetal and perinatal monitoring; Medical sciences; Netherlands; posthaemorrhagic ventricular dilatation; preterm infants; Retrospective Studies; Time Factors; Treatment Outcome; Ventriculoperitoneal Shunt
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2002.tb01697.x

Posthaemorrhagic ventricular dilatation (PHVD) in very preterm infants carries a poor prognosis. As earlier studies have failed to show a benefit of early intervention, it is recommended that PHVD be first treated when head circumference is rapidly increasing and/or when symptoms of raised intracranial pressure develop. Infants with PHVD, admitted to 5 of the 10 Dutch neonatal intensive care units were studied retrospectively, to investigate whether there was a difference in the time of onset of treatment of PHVD and, if so, whether this was associated with a difference in the requirement of a ventriculo‐peritoneal (VP) shunt and/or neurodevelopmental outcome. The surviving infants with a gestational age ≤34 wk, born between 1992 and 1996, diagnosed as having a grade III haemorrhage according to Papile on cranial ultrasound and who developed PHVD were included in the study. PHVD was defined as a ventricular index (VI) exceeding the 97th percentile according to Levene (1981), and severe PHVD as a VI crossing the p 97 + 4 mm line. Ninety‐five infants met the entry criteria. Intervention was not deemed necessary in 22 infants, because of lack of progression. In 31 infants lumbar punctures (LP) were done before the p 97 + 4 mm line was crossed (early intervention). In 20/31 infants, stabilization occurred. In 9 a subcutaneous reservoir was placed, with subsequent stabilization in 6. In 5/31 infants a VP shunt was eventually inserted. In 42 infants treatment was started once the p 97 + 4 mm line was crossed (late intervention). In 30 infants LPs were performed and in 17 of these a VP shunt was eventually inserted. In 11 infants a subcutaneous reservoir was immediately inserted and in 8 of these infants a VP shunt was needed. In one infant a VP shunt was immediately inserted, without any other form of treatment. Infants with late intervention crossed the p 97+ 4 mm earlier (p 0.03) and needed a shunt (26/42; 62%) more often than those with early intervention (5/31; 16%). Early LP was associated with a strongly reduced risk of VP‐shunting (odds ratio = 0.22, 95% confidence interval: 0.08–0.62). The number of infants who developed a moderate or severe handicap was also higher (11/42; 26%) in the late intervention group, compared with those not requiring any intervention (3/22; 14%) or treated early (5/31; 16%). Conclusion: In this retrospective study, infants receiving late intervention required shunt insertion significantly more often than those treated early. A