Ventricular Dilation Following Periventricular-Intraventricular Hemorrhage: Outcome at Age 1 Year

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 158-162
Author(s):  
Walter C. Allan ◽  
Douglas A. Dransfield ◽  
Alison M. Tito
Keyword(s):  
Intraventricular Hemorrhage ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Expectant Management ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Neurodevelopmental Delay ◽  
Ventriculoperitoneal Shunting ◽  
Neurodevelopmental Abnormalities

Ventricular dilation following periventricular-intraventricular hemorrhage can be managed without ventriculoperitoneal shunting in most cases. Twenty-six patients who had periventricular-intraventricular hemorrhage with subsequent ventricular dilation were examined at 1 year of age for neurodevelopmental outcome and hydrocephalus. As previously reported, ventricular dilation may be divided into two groups: ventriculomegaly and posthemorrhagic hydrocephalus. Fourteen patients with ventriculomegaly were followed up with serial ultrasound observations only, and 12 patients with posthemorrhagic hydrocephalus had temporary drainage of ventricular fluid. Only three patients with posthemorrhagic hydrocephalus required ventriculoperitoneal shunting in the neonatal period. Neurodevelopmental abnormalities were found in eight infants who had posthemorrhagic hydrocephalus and two who had ventriculomegaly. Six of these infants had intraparenchymal injury demonstrated by ultrasound, five as a result of the original hemorrhage and 1 by infection. A single infant with posthemorrhagic hydrocephalus, discharged from the hospital with stable ventricular size, developed hydrocephalus and neurodevelopmental delay after the neonatal period. This reversed with ventriculopenitoneal shunting at 1 year of age. It is suggested that even in patients developing ventricular dilation following periventricular-intraventricular hemorrhage, it is the primary intraparenchymal injury that is responsible for subsequent morbidity. Thus, provided serial reevaluations are possible, an expectant management of ventricular dilation is justified.

Posthemorrhagic Hydrocephalus

1989 ◽  
Vol 4 (1_suppl) ◽  
pp. S23-S31 ◽  
Author(s):  
Philip J. Holt
Keyword(s):  
Intraventricular Hemorrhage ◽  
Treatment Options ◽  
Cranial Ultrasound ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Ultrasound Studies ◽  
Grading Systems ◽  
Mantle Thickness ◽  
Parenchymal Damage

Post hemorrhagic hydrocephalus (PHH) can be defined as progressive dilation of the ventricular system that develops as a complication of neonatal intraventricular hemorrhage (IVH). Grading systems exist to quantify IVH but not this secondary ventricular dilation. Cranial ultrasound techniques and measuring methods that allow a uniform, objective grading convention for ventricular enlargement are presented. A biventricular to biparietal ratio (BV:BD) can be measured in the coronal images. A ventricular diameter (VD) can be measured in the sagittal images. Cortical mantle thickness and ventricular size can be measured in the axial images. These measurements allow more precise identification of changes in ventricular size which may have treatment implications. The clinical features of PHH and treatment options are also reviewed. No one treatment modality has proven superior, and neurologic outcome does not correlate with development or resolution of PHH. Better description of parenchymal damage is needed during routine ultrasound studies and development of other modalities to assess parenchymal function need to be developed before the significance of IVH and PHH can be fully understood. (J Child Neurol 1989;4:S23-S31).

scholarly journals Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention

2021 ◽  
pp. 1-11
Author(s):  
Mounica Paturu ◽  
Regina L. Triplett ◽  
Siddhant Thukral ◽  
Dimitrios Alexopoulos ◽  
Christopher D. Smyser ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Mri ◽  
Neurodevelopmental Outcome ◽  
Optimal Time ◽  
Preterm Neonates ◽  
Third Ventriculostomy ◽  
Cranial Ultrasound ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Ventricle Size

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks’ gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson’s r = −0.403, p = 0.046) and improved cognitive (r = −0.554, p = 0.047), motor (r = −0.487, p = 0.048), and language (r = −0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = −0.483, p = 0.014) and improved cognitive (r = −0.711, p = 0.001), motor (r = −0.675, p = 0.003), and language (r = −0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.

A Potential Mechanism of Pathogenesis for Early Posthemorrhagic Hydrocephalus in the Premature Newborn

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 19-21
Author(s):  
Alan Hill ◽  
Gary D. Shackelford ◽  
Joseph J. Volpe
Keyword(s):  
Particulate Matter ◽  
Posterior Fossa ◽  
Intraventricular Hemorrhage ◽  
Ventricular System ◽  
Potential Mechanism ◽  
Ultrasound Scanning ◽  
Csf Flow ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Expected Time

Ventricular dilation is common following intraventricular hemorrhage. Neuropathologic studies have demonstrated that chronic posthemorrhagic hydrocephalus most commonly is a result of an obliterative arachnoiditis in the posterior fossa or is due to obstruction of flow of CSF within the ventricular system. Recent use of ultrasound scanning has demonstrated the occurrence of ventricular dilation within days of intraventricular hemorrhage (prior to the expected time of development of arachnoiditis). In the case described, serial realtime ultrasound scans demonstrated small mobile particles within dilated ventricles seven days following intraventicular hemorrhage. There was no obstruction of CSF flow within the ventricular system. Thus, in this case, ventricular dilation may have been secondary to plugging of arachnoid villi by the small particulate matter and, as a consequence, decrease in CSF reabsorption.

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

2012 ◽  
Vol 9 (5) ◽  
pp. 473-481 ◽  
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.

scholarly journals Anatomical configurations associated with posthemorrhagic hydrocephalus among premature infants with intraventricular hemorrhage

2016 ◽  
Vol 41 (5) ◽  
pp. E5 ◽  
Author(s):  
Hannah M. Tully ◽  
Tara L. Wenger ◽  
Walter A. Kukull ◽  
Dan Doherty ◽  
William B. Dobyns
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Surgical Planning ◽  
Surgical Intervention ◽  
Brain Mri ◽  
Mr Images ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
The Mean ◽  
Grade Iii

OBJECTIVE Intraventricular hemorrhage (IVH) is a complication of prematurity often associated with ventricular dilation, which may resolve over time or progress to posthemorrhagic hydrocephalus (PHH). This study investigated anatomical factors that could predispose infants with IVH to PHH. METHODS The authors analyzed a cohort of premature infants diagnosed with Grade III or IV IVH between 2004 and 2014. Using existing ultrasound and MR images, the CSF obstruction pattern, skull shape, and brain/skull ratios were determined, comparing children with PHH to those with resolved ventricular dilation (RVD), and comparing both groups to a set of healthy controls. RESULTS Among 110 premature infants with Grade III or IV IVH, 65 (59%) developed PHH. Infants with PHH had more severe ventricular dilation compared with those with RVD, although ranges overlapped. Intraventricular CSF obstruction was observed in 36 (86%) of 42 infants with PHH and 0 (0%) of 18 with RVD (p < 0.001). The distribution of skull shapes in infants with PHH was similar to those with RVD, although markedly different from controls. No significant differences in supratentorial brain/skull ratio were observed; however, the mean infratentorial brain/skull ratio of infants with PHH was 5% greater (more crowded) than controls (p = 0.006), whereas the mean infratentorial brain/skull ratio of infants with RVD was 8% smaller (less crowded) than controls (p = 0.004). CONCLUSIONS Among premature infants with IVH, intraventricular obstruction and infratentorial crowding are strongly associated with PHH, further underscoring the need for brain MRI in surgical planning. Prospective studies are required to determine which factors are cause and which are consequence, and which can be used to predict the need for surgical intervention.

scholarly journals Ventricular Dilation Following Intraventricular Hemorrhage in the Premature Infant

1983 ◽  
Vol 10 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Alan Hill
Keyword(s):  
Cerebrospinal Fluid ◽  
Intraventricular Hemorrhage ◽  
Clinical Signs ◽  
Normal Pressure ◽  
Ventricular Drainage ◽  
Ventricular Size ◽  
Anterior Fontanelle ◽  
Ventricular Dilation ◽  
Hemorrhagic Lesion ◽  
Choice Of Therapy

SUMMARY:Periventricular/intraventricular hemorrhage occurs commonly in the premature newborn. Recent studies indicate an incidence of 35–45%. Following PVH/IVH, the likelihood of developing hydrocephalus is related to the severity of the hemorrhagic lesion. Ventricular dilation may be due to an obliterative arachnoiditis affecting principally the posterior fossa or, less commonly, due to obstruction of flow of cerebrospinal fluid within the ventricular system by clots or other debris. With moderate to severe hemorrhagic lesions, ventricular dilation may occur at the time of PVH/IVH. More commonly, progressive dilation begins one to three weeks following PVH/IVH. The classical clinical signs of hydrocephalus, ie. bulging of anterior fontanelle and inappropriate increase in head circumference, may not appear for days to weeks following onset of ventricular dilation. The precise significance of such normal-pressure hydrocephalus in the genesis of brain injury in the newborn is unknown. Following diagnosis of PVH/IVH, close surveillance of ventricular size with ultrasound scans is indicated. When there is slowly progressive ventricular dilation with normal intracranial pressure, the choice of therapy is made difficult because of frequent spontaneous arrest in such cases. Several modes of therapy have been reported including drugs to decrease the formation of cerebrospinal fluid and the use of serial lumbar punctures. When ventricular dilation is rapid with intracranial hypertension, ventricular drainage is indicated.

Normal Pressure Hydrocephalus in the Newborn

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 623-629
Author(s):  
Alan Hill ◽  
Joseph J. Volpe
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Normal Pressure Hydrocephalus ◽  
Intraventricular Hemorrhage ◽  
Early Recognition ◽  
Normal Pressure ◽  
Progressive Increase ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Stable Period

The entity of normal pressure hydrocephalus (NPH) following intraventricular hemorrhage in the newborn has been characterized. Of 87 infants with intraventricular hemorrhage, 20 had early and rapidly progressive hydrocephalus with intracranial hypertension and/or death. In 47 cases there was no increase in ventricular size and in 20 cases there was progressive increase in ventricular size with normal intracranial pressure, ie, NPH. Of these infants with NPH, nine had spontaneous arrest with or without resolution of ventriculomegaly, beginning within 31 days of onset. In 11 cases, after a stable period of NPH lasting 12 to 84 days, there was progressive increase in ventricular size accompanied ultimately by raised intracranial pressure. A relationship between the degree of ventriculomegaly and severity of intraventricular hemorrhage was demonstrated. The data thus define a state of NPH after intraventricular hemorrhage and indicate that approximately half of such cases will not develop progressive hydrocephalus with increased intracranial pressure. If arrest or onset of resolution of ventriculomegaly is not apparent within approximately one month, continued progression and necessity for intervention are to be expected. Serial measurements of intracranial pressure and ventricular size in newborns with posthemorrhagic ventricular dilation allow the diagnosis of NPH and permit early recognition of rapidly progressive ventricular dilation with intracranial hypertension which may follow a stable period of NPH. Such early recognition of this potentially harmful state allows prompt ventricular drainage, thereby preventing brain compression.

scholarly journals Treatment of posthemorrhagic ventricular dilation in preterm infants: a systematic review and meta-analysis of outcomes and complications

2015 ◽  
Vol 16 (5) ◽  
pp. 545-555 ◽  
Author(s):  
Jetan H. Badhiwala ◽  
Chris J. Hong ◽  
Farshad Nassiri ◽  
Brian Y. Hong ◽  
Jay Riva-Cambrin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Premature Infants ◽  
Meta Analysis ◽  
Demographic Data ◽  
External Ventricular Drain ◽  
Neurodevelopmental Outcome ◽  
Cochrane Library ◽  
Ventricular Dilation ◽  
Eligibility Criteria ◽  
Posthemorrhagic Hydrocephalus

OBJECT The optimal clinical management of intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilation (PHVD)/posthemorrhagic hydrocephalus (PHH) in premature infants remains unclear. A common approach involves temporary treatment of hydrocephalus in these patients with a ventriculosubgaleal shunt (VSGS), ventricular access device (VAD), or external ventricular drain (EVD) until it becomes evident that the patient needs and can tolerate permanent CSF diversion (i.e., ventriculoperitoneal shunt). The present systematic review and meta-analysis aimed to provide a robust and comprehensive summary of the published literature regarding the clinical outcomes and complications of these 3 techniques as temporizing measures in the management of prematurity-related PHVD/PHH. METHODS The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library for studies published through December 2013 on the use of VSGSs, VADs, and/or EVDs as temporizing devices for the treatment of hydrocephalus following IVH in the premature neonate. Data pertaining to patient demographic data, study methods, interventions, and outcomes were extracted from eligible articles. For each of the 3 types of temporizing device, the authors performed meta-analyses examining 6 outcomes of interest, which were rates of 1) obstruction; 2) infection; 3) arrest of hydrocephalus (i.e., permanent shunt independence); 4) mortality; 5) good neurodevelopmental outcome; and 6) revision. RESULTS Thirty-nine studies, representing 1502 patients, met eligibility criteria. All of the included articles were observational studies; 36 were retrospective and 3 were prospective designs. Nine studies (n = 295) examined VSGSs, 24 (n = 962) VADs, and 9 (n = 245) EVDs. Pooled rates of outcome for VSGS, VAD, and EVD, respectively, were 9.6%, 7.3%, and 6.8% for obstruction; 9.2%, 9.5%, and 6.7% for infection; 12.2%, 10.8%, and 47.3% for revision; 13.9%, 17.5%, and 31.8% for arrest of hydrocephalus; 12.1%, 15.3%, and 19.1% for death; and 58.7%, 50.1%, and 56.1% for good neurodevelopmental outcome. CONCLUSIONS This study provides robust estimates of outcomes for the most common temporizing treatments for IVH in premature infants. With few exceptions, the range of outcomes was similar for VSGS, VAD, and EVD.

scholarly journals Neurodevelopmental Outcome of High Risk Babies at One Year of Age Born in a Tertiary Centre

2017 ◽  
Vol 37 (1) ◽  
pp. 45-50
Author(s):  
Merina Shrestha ◽  
Luna Bajracharya ◽  
Laxman Shrestha
Keyword(s):  
High Risk ◽  
Congenital Anomalies ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Single Item ◽  
Tertiary Centre ◽  
Developmental Domains ◽  
One Year ◽  
High Risk Clinic

Introduction: With increasing survival of high risk babies, children with different developmental disabilities have emerged as a challenge for the baby, family as well as for physicians. With limited awareness and resources, follow-up and interventions for these babies are difficult. The study was carried out to find out the development of high risk babies in different developmental domains at one year of age.Material and Methods: NICU graduates who visited high risk clinic at one year of age were assessed. ASQ-3 was used to screen development. Children with major congenital anomalies and syndromes were excluded from the study.Results: Out of 28 high risk babies, about 29% had global delay. Those babies who had seizure during neonatal period could not score even in single item of ASQ-3. Conclusion: All high risk babies are at risk of developing delay hence should be followed up regularly. Timely early intervention needs to be started to minimize delay.  

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