1068 Can Loss of Sleep-Awake Cyclicity at Aeeg Predict Posthemorrhagic Hydrocephalus in Preterm Infants with Intraventricular Hemorrhage?

Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.

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Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.1.peds11292 ◽

2012 ◽

Vol 9 (5) ◽

pp. 473-481 ◽

Cited By ~ 29

Author(s):

Jay Riva-Cambrin ◽

Chevis N. Shannon ◽

Richard Holubkov ◽

William E. Whitehead ◽

Abhaya V. Kulkarni ◽

...

Keyword(s):

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Practice Patterns ◽

Clinical Findings ◽

Research Network ◽

Ventricular Size ◽

Posthemorrhagic Hydrocephalus ◽

Center Effect ◽

Csf Diversion ◽

Ventricular Reservoir

Object There is little consensus regarding the indications for surgical CSF diversion (either with implanted temporizing devices [reservoir or subgaleal shunt] or shunt alone) in preterm infants with posthemorrhagic hydrocephalus. The authors determined clinical and neuroimaging factors associated with the use of surgical CSF diversion among neonates with intraventricular hemorrhage (IVH), and describe variations in practice patterns across 4 large pediatric centers. Methods The use of implanted temporizing devices and conversion to permanent shunts was examined in a consecutive sample of 110 neonates surgically treated for IVH related to prematurity from the 4 clinical centers of the Hydrocephalus Clinical Research Network (HCRN). Clinical, neuroimaging, and so-called processes of care factors were analyzed. Results Seventy-three (66%) of the patients underwent temporization procedures, including 50 ventricular reservoir and 23 subgaleal shunt placements. Center (p < 0.001), increasing ventricular size (p = 0.04), and bradycardia (p = 0.07) were associated with the use of an implanted temporizing device, whereas apnea, occipitofrontal circumference (OFC), and fontanel assessments were not. Implanted temporizing devices were converted to permanent shunts in 65 (89%) of the 73 neonates. Only a full fontanel (p < 0.001) and increased ventricular size (p = 0.002) were associated with conversion of the temporizing devices to permanent shunts, whereas center, OFCs, and clot characteristics were not. Conclusions Considerable center variability exists in neurosurgical approaches to temporization of IVH in prematurity within the HCRN; however, variation between centers is not seen with permanent shunting. Increasing ventricular size—rather than classic clinical findings such as increasing OFCs—represents the threshold for either temporization or shunting of CSF.

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Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000–2010

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.7.peds15140 ◽

2016 ◽

Vol 17 (3) ◽

pp. 260-269 ◽

Cited By ~ 48

Author(s):

Eisha A. Christian ◽

Diana L. Jin ◽

Frank Attenello ◽

Timothy Wen ◽

Steven Cen ◽

...

Keyword(s):

Length Of Stay ◽

Preterm Infants ◽

Hospital Cost ◽

Intraventricular Hemorrhage ◽

Preterm Births ◽

The United States ◽

Preterm Neonates ◽

Average Hospital ◽

Posthemorrhagic Hydrocephalus ◽

Congenital Cardiac Anomalies

OBJECT Even with improved prenatal and neonatal care, intraventricular hemorrhage (IVH) occurs in approximately 25%–30% of preterm infants, with a subset of these patients developing hydrocephalus. This study was undertaken to describe current trends in hospitalization of preterm infants with posthemorrhagic hydrocephalus (PHH) using the Nationwide Inpatient Sample (NIS) and the Kids’ Inpatient Database (KID). METHODS The KID and NIS were combined to generate data for the years 2000–2010. All neonatal discharges with ICD-9-CM codes for preterm birth with IVH alone or with IVH and hydrocephalus were included. RESULTS There were 147,823 preterm neonates with IVH, and 9% of this group developed hydrocephalus during the same admission. Of patients with Grade 3 and 4 IVH, 25% and 28%, respectively, developed hydrocephalus in comparison with 1% and 4% of patients with Grade 1 and 2 IVH, respectively. Thirty-eight percent of patients with PHH had permanent ventricular shunts inserted. Mortality rates were 4%, 10%, 18%, and 40%, respectively, for Grade 1, 2, 3, and 4 IVH during initial hospitalization. Length of stay has been trending upward for both groups of IVH (49 days in 2000, 56 days in 2010) and PHH (59 days in 2000, 70 days in 2010). The average hospital cost per patient (adjusted for inflation) has also increased, from $201,578 to $353,554 (for IVH) and $260,077 to $495,697 (for PHH) over 11 years. CONCLUSIONS The number of neonates admitted with IVH has increased despite a decrease in the number of preterm births. Rates of hydrocephalus and mortality correlated closely with IVH grade. The incidence of hydrocephalus in preterm infants with IVH remained stable between 8% and 10%. Over an 11-year period, there was a progressive increase in hospital cost and length of stay for preterm neonates with IVH and PHH that may be explained by a concurrent increase in the proportion of patients with congenital cardiac anomalies.

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Intraventricular hemorrhage and posthemorrhagic hydrocephalus in preterm infants: diagnosis, classification, and treatment options

Child s Nervous System ◽

10.1007/s00381-019-04127-x ◽

2019 ◽

Vol 35 (6) ◽

pp. 917-927 ◽

Cited By ~ 7

Author(s):

Paola Valdez Sandoval ◽

Paola Hernández Rosales ◽

Deyanira Gabriela Quiñones Hernández ◽

Eva Alejandra Chavana Naranjo ◽

Victor García Navarro

Keyword(s):

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Treatment Options ◽

Posthemorrhagic Hydrocephalus ◽

Diagnosis Classification ◽

Classification And Treatment

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Osteopathic status of preterm infants with intraventricular hemorrhage

Russian Osteopathic Journal ◽

10.32885/2220-0975-2020-4-64-73 ◽

2020 ◽

pp. 64-73

Author(s):

L. K. Karimova ◽

J. O. Kuzmina ◽

Z. N. Zinnurova ◽

E. M. Vasilevskaja

Keyword(s):

Preterm Infants ◽

Intraventricular Hemorrhage

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Faculty Opinions recommendation of Delayed cord clamping is associated with improved dynamic cerebral autoregulation and decreased incidence of intraventricular hemorrhage in preterm infants.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735681405.793567669 ◽

2019 ◽

Author(s):

Michael Johnston

Keyword(s):

Preterm Infants ◽

Cerebral Autoregulation ◽

Intraventricular Hemorrhage ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Dynamic Cerebral Autoregulation

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Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

Pediatric Neurosurgery ◽

10.1159/000516183 ◽

2021 ◽

pp. 1-9

Author(s):

Jorge Tirado-Caballero ◽

Jorge Herreria-Franco ◽

Mónica Rivero-Garvía ◽

Gloria Moreno-Madueño ◽

Maria Jose Mayorga-Buiza ◽

...

Keyword(s):

Preterm Infants ◽

Cerebrospinal Fluid Leak ◽

Tips And Tricks ◽

Germinal Matrix ◽

Suitable Alternative ◽

Posthemorrhagic Hydrocephalus ◽

Mortality And Morbidity ◽

Germinal Matrix Hemorrhage ◽

Preoperative Stage ◽

Fluid Leak

Introduction: Posthemorrhagic hydrocephalus in preterm infants is a serious entity related to high mortality and morbidity. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. However, as with every endoscopic technique, it requires some experience and several cases to master. Methods: We present a descriptive study of some technical nuances, tips, and tricks that have been learned in the last 8 years with over a hundred NELs performed in preterm infants. These variations are classified into 3 categories according to their temporal relationship with the surgical procedure: preoperative stage, intraoperative stage, and postoperative stage. We include a brief description of each one and the reasons why they are included in our current clinical practice. Results: Twenty tips and pearls were described in detail and are reported here. Preoperative, intraoperative, and postoperative variations were exposed and related to the most frequent complications of this procedure: infection, cerebrospinal fluid leak, and rebleeding. Conclusions: NEL is a useful technique for the management of germinal matrix hemorrhage in preterm infants. These technical nuances have improved the results of our technique and helped us to prevent complications related to the procedure.

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