Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

Abstract

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.

Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience

“…The incidence of severe IVH also remained relatively constant. This clinical pattern is similar to that in some recent reports of outcomes during the past decade for very preterm infants, 14,16 but not in others. 6 In this study, a relatively high proportion (55.4%) of ELGANs with severe IVH had ventricular dilation noted on at least 1 cranial ultrasonography examination performed at some point during the neonatal hospitalization.…”

Role of Hemoglobin and Iron in Hydrocephalus After Neonatal Intraventricular Hemorrhage

“…Hydrocephalus develops in up to 1/3 of patients with IVH and often requires lifelong treatment. 2, 18 There are no targeted preventive treatments for hydrocephalus due to our lack of understanding of how IVH results in ventricular enlargement. In this study, we demonstrate that intraventricular hemoglobin and iron, components of red blood cells, are capable of inducing ventricular dilation in neonatal rats and that iron chelation reduces hemoglobin-induced ventricular enlargement.…”

Erythropoietin for the Repair of Cerebral Injury in Very Preterm Infants (EpoRepair)

“…One of the most consistent predictors of neurodevelopmental impairment in preterm infants is intraventricular hemorrhage (IVH) [1,2,3], which is recognized in the first few days of life (DOL) by cranial ultrasound, the standard imaging tool for the diagnosis of cerebral lesions in preterm infants and graded according to the classification of Papile et al [4]. …”