Post-haemorrhagic hydrocephalus is associated with poorer surgical and neurodevelopmental sequelae than other causes of infant hydrocephalus

Abstract

Purpose This retrospective cohort study aimed to investigate the surgical and neurodevelopmental outcomes (NDO) of infant hydrocephalus. We also sought to determine whether these outcomes are disproportionately poorer in post-haemorrhagic hydrocephalus (PHH) compared to other causes of infant hydrocephalus. Methods A review of all infants with hydrocephalus who had ventriculoperitoneal (VP) shunts inserted at Great Ormond Street Hospital (GOSH) from 2008 to 2018 was performed. Demographic, surgical, neurodevelopmental, and other clinical data extracted from electronic patient notes were analysed by aetiology. Shunt survival, NDO, cerebral palsy (CP), epilepsy, speech delay, education, behavioural disorders, endocrine dysfunction, and mortality were evaluated. Results A total of 323 infants with median gestational age of 37.0 (23.29–42.14) weeks and birthweight of 2640 g (525–4684 g) were evaluated. PHH was the most common aetiology (31.9%) and was associated with significantly higher 5-year shunt revision rates, revisions beyond a year, and median number of revisions than congenital or “other” hydrocephalus (all p < 0.02). Cox regression demonstrated poorest shunt survival in PHH, related to gestational age at birth and corrected age at shunt insertion. PHH also had the highest rate of severe disabilities, increasing with age to 65.0% at 10 years, as well as the highest CP rate; only genetic hydrocephalus had significantly higher endocrine dysfunction (p = 0.01) and mortality rates (p = 0.04). Conclusions Infants with PHH have poorer surgical and NDO compared to all other aetiologies, except genetic hydrocephalus. Research into measures of reducing neurodisability following PHH is urgently required. Long-term follow-up is essential to optimise support and outcomes.

Modelling success after perinatal post-haemorrhagic hydrocephalus: a single-centre study

“…The negative association with head circumference is likely to be related to the severity of hydrocephalus that has developed in the infant by the time of shunt insertion. Taken together, this modelling suggests that while it is advisable to defer permanent shunting until the infant is older, as has been suggested previously, this must be balanced with the degree of hydrocephalus that can develop in this period and patients should be very carefully temporised in the interim to avoid excess increases in head circumference [9,10].…”

“…Despite its prevalence, there remains considerable uncertainty about the optimal management of PHH, both with regard to the timing of permanent shunt insertion and the method of managing CSF volume before any permanent shunting [5,6]. This clinical uncertainty is borne in the context of poor outcomes for this cohort, with higher rates of shunt failure and neurodevelopmental disability compared to patients with other aetiologies of paediatric hydrocephalus [7][8][9].…”

Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma

“…It is important to note however that whilst posthaemorrhagic hydrocephalus is likely to be a contributory factor to outcome, this is unlikely to be solely responsible for the observed neurodevelopmental delay. For example, the outcome following isolated neonatal hydrocephalus i.e., not related to IVH, is significantly better than that caused by IVH ( 39 ). Implicating that whilst important, hydrocephalus may not be the driver of outcome.…”

“…Implicating that whilst important, hydrocephalus may not be the driver of outcome. It is also interesting to note that the burden of care in patients with hydrocephalus secondary to IVH is more significant than other causes of hydrocephalus ( 39 ).…”

Neuroendoscopic lavage versus traditional surgical methods for the early management of posthemorrhagic hydrocephalus in neonates

“…Despite the dramatic improvement in the quality of medical care, the incidence of intracerebral hemorrhage in premature infants remains as high as 25-30% and its complications (mainly post-hemorrhagic hydrocephalus) constitute the additional brain-damaging factors that are caused, on the one hand, by the direct impact of high intracranial pressure on nerve structures, and on the other hand, by the additional immune response triggered by blood and its breakdown products, which get into the ventricles and provokes further damage to the nerve cells [2][3][4]. It is well estimated that infants with PHH have poorer surgical and neurodevelopmental outcomes [4,5]. At present, the main goals of intraventricular hemorrhage treatment are reduction of the need for a fluid drainage device (shunt) and protection of nerve structures from further progressive damage [6][7][8][9].…”