Neurodevelopmental outcome at 2 years after neuroendoscopic lavage in neonates with posthemorrhagic hydrocephalus

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  • 1 Pediatric Neurosurgery,
  • 2 Neuroradiology,
  • 3 Pediatric Neurology,
  • 4 Neonatology, and
  • 5 Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Germany
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OBJECTIVE

A standardized guideline for treatment of posthemorrhagic hydrocephalus in premature infants is still missing. Because an early ventriculoperitoneal shunt surgery is avoided due to low body weight and fragility of the patients, the neurosurgical treatment focuses on temporary solutions for CSF diversion as a minimally invasive approach. Neuroendoscopic lavage (NEL) was additionally introduced for early elimination of intraventricular blood components to reduce possible subsequent complications such as shunt dependency, infection, and multiloculated hydrocephalus. The authors report their first experience regarding neurodevelopmental outcome after NEL in this patient cohort.

METHODS

In a single-center retrospective cohort study with 45 patients undergoing NEL, the authors measured neurocognitive development at 2 years with the Bayley Scales of Infant Development, 2nd Edition, Mental Developmental Index (BSID II MDI) and graded the ability to walk with the Gross Motor Function Classification System (GMFCS). They further recorded medication with antiepileptic drugs (AEDs) and quantified ventricular and brain volumes by using 3D MRI data sets.

RESULTS

Forty-four patients were alive at 2 years of age. Eight of 27 patients (30%) assessed revealed a fairly normal neurocognitive development (BSID II MDI ≥ 70), 28 of 36 patients (78%) were able to walk independently or with minimal aid (GMFCS 0–2), and 73% did not require AED treatment. Based on MR volume measurements, greater brain volume was positively correlated with BSID II MDI (rs = 0.52, 95% CI 0.08–0.79) and negatively with GMFCS (rs = −0.69, 95% CI −0.85 to −0.42). Based on Bayesian logistic regression, AED treatment, the presence of comorbidities, and also cerebellar pathology could be identified as relevant risk factors for both neurodevelopmental outcomes, increasing the odds more than 2-fold—but with limited precision in estimation.

CONCLUSIONS

Neuromotor outcome assessment after NEL is comparable to previously published drainage, irrigation, and fibrinolytic therapy (DRIFT) study results. A majority of NEL-treated patients showed independent mobility. Further validation of outcome measurements is warranted in an extended setup, as intended by the prospective international multicenter registry for treatment of posthemorrhagic hydrocephalus (TROPHY).

ABBREVIATIONS AED = antiepileptic drug; BSID II MDI = Bayley Scales of Infant Development, 2nd Edition, Mental Developmental Index; CI = confidence interval; CrI = credible interval; CSF = cerebrospinal fluid; DRIFT = drainage, irrigation, and fibrinolytic therapy; GMFCS = Gross Motor Function Classification System; IQR = interquartile range; IVH = intraventricular hemorrhage; NEL = neuroendoscopic lavage; OR = odds ratio.

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Contributor Notes

Correspondence Ulrich-Wilhelm Thomale: Charité—Universitätsmedizin Berlin, Germany. uthomale@charite.de.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.PEDS20211.

A.A. and U.W.T. contributed equally to this study.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Badhiwala JH, Hong CJ, Nassiri F, Treatment of posthemorrhagic ventricular dilation in preterm infants: a systematic review and meta-analysis of outcomes and complications. J Neurosurg Pediatr. 2015;16(5):545555.

    • Search Google Scholar
    • Export Citation
  • 2

    Etus V, Kahilogullari G, Karabagli H, Unlu A. Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus: a feasible treatment option or not? A multicenter study. Turk Neurosurg. 2018;28(1):137141.

    • Search Google Scholar
    • Export Citation
  • 3

    Christian EA, Melamed EF, Peck E, Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant. J Neurosurg Pediatr. 2016;17(3):278284.

    • Search Google Scholar
    • Export Citation
  • 4

    d’Arcangues C, Schulz M, Bührer C, Extended experience with neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates. World Neurosurg. 2018;116:e217e224.

    • Search Google Scholar
    • Export Citation
  • 5

    Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529534.

    • Search Google Scholar
    • Export Citation
  • 6

    Cherian S, Whitelaw A, Thoresen M, Love S. The pathogenesis of neonatal post-hemorrhagic hydrocephalus. Brain Pathol. 2004;14(3):305311.

    • Search Google Scholar
    • Export Citation
  • 7

    Whitelaw A, Jary S, Kmita G, Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics. 2010;125(4):e852e858.

    • Search Google Scholar
    • Export Citation
  • 8

    Gram M, Sveinsdottir S, Cinthio M, Extracellular hemoglobin—mediator of inflammation and cell death in the choroid plexus following preterm intraventricular hemorrhage. J Neuroinflammation. 2014;11:200.

    • Search Google Scholar
    • Export Citation
  • 9

    Limbrick DD Jr, Mathur A, Johnston JM, Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study. J Neurosurg Pediatr. 2010;6(3):224230.

    • Search Google Scholar
    • Export Citation
  • 10

    Whitelaw A, Evans D, Carter M, Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants: brain-washing versus tapping fluid. Pediatrics. 2007;119(5):e1071e1078.

    • Search Google Scholar
    • Export Citation
  • 11

    Luyt K, Jary S, Lea C, Ten-year follow-up of a randomised trial of drainage, irrigation and fibrinolytic therapy (DRIFT) in infants with post-haemorrhagic ventricular dilatation. Health Technol Assess. 2019;23(4):1116.

    • Search Google Scholar
    • Export Citation
  • 12

    Schulz M, Bührer C, Pohl-Schickinger A, Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr. 2014;13(6):626635.

    • Search Google Scholar
    • Export Citation
  • 13

    Palisano R, Rosenbaum P, Bartlett D, GMFCS E&R Gross Motor Function Classification System Expanded and Revised. CanChild Centre for Childhood Disability Research; 2007.

    • Search Google Scholar
    • Export Citation
  • 14

    Palisano R, Rosenbaum P, Walter S, Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214223.

    • Search Google Scholar
    • Export Citation
  • 15

    Yushkevich PA, Piven J, Hazlett HC, User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage. 2006;31(3):11161128.

    • Search Google Scholar
    • Export Citation
  • 16

    Gelman A, Jakulin A, Pittau M, A weakly informative default prior distribution for logistic and other regression models. Ann Appl Stat. 2009;2(4):13601383.

    • Search Google Scholar
    • Export Citation
  • 17

    R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing; 2019.

  • 18

    Wickham H, Averick M, Bryan J, Welcome to Tidyverse. J Open Source Softw. 2019;4(43):1686.

  • 19

    Signorell A, Aho K, Alfons A, DescTools: Tools for Descriptive Statistics. R package; 2020.

  • 20

    Gelman A, Hill J. Data Analysis Using Regression and Multilevel/Hierarchical Models. Cambridge University Press; 2006

  • 21

    van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):167.

  • 22

    Cherukuri V, Ssenyonga P, Warf BC, Learning based segmentation of CT brain images: application to postoperative hydrocephalic scans. IEEE Trans Biomed Eng. 2018;65(8):18711884.

    • Search Google Scholar
    • Export Citation
  • 23

    Klimont M, Flieger M, Rzeszutek J, Automated ventricular system segmentation in paediatric patients treated for hydrocephalus using deep learning methods. Biomed Res Int. 2019;2019:3059170.

    • Search Google Scholar
    • Export Citation
  • 24

    Kulkarni AV, Schiff SJ, Mbabazi-Kabachelor E, Endoscopic treatment versus shunting for infant hydrocephalus in Uganda. N Engl J Med. 2017;377(25):24562464.

    • Search Google Scholar
    • Export Citation
  • 25

    Mandell JG, Langelaan JW, Webb AG, Schiff SJ. Volumetric brain analysis in neurosurgery: Part 1. Particle filter segmentation of brain and cerebrospinal fluid growth dynamics from MRI and CT images. J Neurosurg Pediatr. 2015;15(2):113124.

    • Search Google Scholar
    • Export Citation
  • 26

    Brouwer MJ, de Vries LS, Kersbergen KJ, Effects of posthemorrhagic ventricular dilatation in the preterm infant on brain volumes and white matter diffusion variables at term-equivalent age. J Pediatr. 2016;168:4149.e1.

    • Search Google Scholar
    • Export Citation
  • 27

    Cioni G, Bertuccelli B, Boldrini A, Correlation between visual function, neurodevelopmental outcome, and magnetic resonance imaging findings in infants with periventricular leucomalacia. Arch Dis Child Fetal Neonatal Ed. 2000;82(2):F134F140.

    • Search Google Scholar
    • Export Citation
  • 28

    Peterson M, Warf BC, Schiff SJ. Normative human brain volume growth. J Neurosurg Pediatr. 2018;21(5):478485.

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