Intraparenchymal hemorrhage after serial ventricular reservoir taps in neonates with hydrocephalus and association with neurodevelopmental outcome at 2 years of age

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  • 1 Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht;
  • | 2 University Medical Center Utrecht, Utrecht Brain Center, Utrecht, The Netherlands;
  • | 3 Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada;
  • | 4 Department of Neonatology, University Hospital Ghent, Ghent, Belgium;
  • | 5 Department of Child Neurology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands;
  • | 6 Department of Neonatology, Hospital Sant Joan de Déu, Barcelona, Spain; and
  • | 7 Division of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands
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OBJECTIVE

Decompressing the ventricles with a temporary device is often the initial neurosurgical intervention for preterm infants with hydrocephalus. The authors observed a subgroup of infants who developed intraparenchymal hemorrhage (IPH) after serial ventricular reservoir taps and sought to describe the characteristics of IPH and its association with neurodevelopmental outcome.

METHODS

In this multicenter, case-control study, for each neonate with periventricular and/or subcortical IPH, a gestational age-matched control with reservoir who did not develop IPH was selected. Digital cranial ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies were assessed. Ventricular measurements were recorded prior to and 3 days and 7 days after reservoir insertion. Changes in ventricular volumes were calculated. Neurodevelopmental outcome was assessed at 2 years corrected age using standardized tests.

RESULTS

Eighteen infants with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls were included. Reduction of the ventricular volumes relative to occipitofrontal head circumference after 7 days of reservoir taps was greater in infants with IPH (mean difference −0.19 [95% CI −0.37 to −0.004], p = 0.04). Cognitive and motor Z-scores were similar in infants with and those without IPH (mean difference 0.42 [95% CI −0.17 to 1.01] and 0.58 [95% CI −0.03 to 1.2]; p = 0.2 and 0.06, respectively). Multifocal IPH was negatively associated with cognitive score (coefficient −0.51 [95% CI −0.88 to −0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient −0.50 [95% CI −1.6 to −0.14], p = 0.02) after adjusting for age at the time of assessment.

CONCLUSIONS

This study reports for the first time that IPH can occur after a rapid reduction of the ventricular volume during the 1st week after the initiation of serial reservoir taps in neonates with hydrocephalus. Further studies on the use of cUS to guide the amount of cerebrospinal fluid removal are warranted.

ABBREVIATIONS

AHW = anterior horn width; BSID-II = Bayley Scales of Infant Development, Second Edition; BSITD-III = Bayley Scales of Infant and Toddler Development, Third Edition; CP = cerebral palsy; cUS = cranial ultrasound; GMDS = Griffiths Mental Development Scales; GMFCS = gross motor function classification system; GMH = germinal matrix hemorrhage; IPH = intraparenchymal hemorrhage; IVH = intraventricular hemorrhage; PHVD = posthemorrhagic ventricular dilatation; PVHI = periventricular hemorrhagic infarction; TEA = term-equivalent age; TOD = thalamooccipital distance; UMCU = University Medical Center Utrecht; VI = ventricular index; VPS = ventriculoperitoneal shunt.

Image from Reynolds et al (pp 703–709).

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