Neurological Prognosis of High-Risk Preterm Infants with Peri-Intraventricular Hemorrhage and Ventricular Dilatation

Abstract

Fifty-eight preterm neonates evaluated by real-time sonographic scanning of the head were prospectively studied. They were divided into three groups: 13 with peri-intraven-tricular hemorrhage (PIVH) alone, 19 with subsequent ventricular dilatation and 26 control infants without ultrasound evidence of PIVH. At 12 months of age detailed neurological follow-up assessment was carried out. Five (8.6%) patients had major handicaps, 34 minor neurological abnormalities. The severity of the PIVH correlated with the neurologic outcome (p < 0.02). The incidence of major handicaps was significantly greater in the group with ventricular dilatation (p < 0.03). Among the infants with PIVH, major handicaps were only present if associated with grade III and IV. Severe posthemorrhagic ventricular dilatation increased the risk for major handicaps. Adverse neurological sequelae at follow-up appeared to be attributable to the extent of PIVH and aggravated by severe ventricular enlargement.

Incidence of peri-intraventricular hemorrhage in premature neonates weighing more than 1500g

“…Although this incidence is considerably below the one described for neonates weighing less than 1500 g [1], this study demonstrates that there is also a substantial risk of PIVH in larger prematures. In this group of neonates all grades of hemorrhages were represented.…”

Cerebrospinal fluid drainage in posthaemorrhagic ventricular dilatation leads to improvement in amplitude‐integrated electroencephalographic activity

“…The voltage criteria of our previous work were applied to dichotomize traces as normal or abnormal, as these provide relative durations of patterns thought to be normal according to GA. aEEG was classified as normal when (1) background patterns appeared to be appropriate for GA (i.e. within 5th to 95th percentile) according to our own reference values (21), 2). Sleep‐wake cycles were present and (3) there were no seizures recorded.…”

“…Intraventricular haemorrhage (IVH) is still a major complication of preterm birth (1). The ensuing posthaemorrhagic ventricular dilatation (PHVD) is known to be associated with subsequent white matter damage and permanent neurodevelopmental disability (2–4). In a rat model of neonatal PHVD (5), white matter loss and reduced motor performance occurred in animals with dilated lateral ventricles.…”

Decompressing posthaemorrhagic ventricular dilatation significantly improves regional cerebral oxygen saturation in preterm infants

“…When drainage of cerebrospinal fluid is impaired due to pathophysiological processes caused by the haemorrhage, posthaemorrhagic ventricular dilatation (PHVD) subsequently develops . PHVD is thought to be associated with profound neurodevelopmental impairment as it leads to increasing intracerebral pressure, distortion and free radical injury with inflammation resulting in white matter injury . Due to the cartilageous structure and the still open sutures of a preterm infant's skull, ventricular width can increase without any clinical sign of increasing intracranial pressure.…”