Abstract

BackgroundIntraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births. Despite a high risk of death and impaired neurodevelopment, the precise prognosis of infants with IVH remains unclear. The objective of this study was to evaluate the rate and predictive factors of evolution to post hemorrhagic hydrocephalus (PHH) requiring a shunt, in newborns with IVH and to report their neurodevelopmental outcomes at 2 years of age.MethodsAmong all preterm newborns admitted to the department of neonatalogy at Rouen University Hospital, France between January 2000 and December 2013, 122 had an IVH and were included in the study. Newborns with grade 1 IVH according to the Papile classification were excluded.ResultsAt 2-year, 18% (n = 22) of our IVH cohort required permanent cerebro spinal fluid (CSF) derivation. High IVH grade, low gestational age at birth and increased head circumference were risk factors for PHH. The rate of death of IVH was 36.9% (n = 45). The rate of cerebral palsy was 55.9% (n = 43) in the 77 surviving patients (49.4%). Risk factors for impaired neurodevelopment were high grade IVH and increased head circumference.ConclusionHigh IVH grade was strongly correlated with death and neurodevelopmental outcome. The impact of an increased head circumference highlights the need for early management. CSF biomarkers and new medical treatments such as antenatal magnesium sulfate have emerged and could predict and improve the prognosis of these newborns with PHH.

Highlights

  • Intraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births

  • The invasion of bleeding in Gilard et al BMC Pediatrics (2018) 18:288 the ventricular system is responsible for post-hemorrhagic hydrocephalus (PHH) [9] due to the obstruction of cerebrospinal fluid (CSF) circulation and to the inflammatory response of the ependyma causing a loss of compliance and a decrease of CSF reabsorption

  • Patients with isolated grade 1 IVH were excluded from the study because it is a frequent situation in preterm child before 30 weeks of gestation (WG) and grade 1 IVH are not associated with post hemorrhagic hydrocephalus (PHH) witout intraventricular bleeding

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Summary

Introduction

Intraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births. Intraventricular hemorrhage (IVH) remains a serious complication in premature children, affecting approximately 20–30% of infants born < 29 weeks estimated gestational age (EGA) [1,2,3]. The physiopathology [6,7,8] of bleeding is based on hemorrhagic transformation of hypoxia-ischemia in the vulnerable subependymal germinal matrix. This location is fed by rich terminal vascularization with an intense metabolism, immature at this step of brain development and highly sensitive to hemodynamic fluctuations. White matter lesions due to intraparenchymal hemorrhage are responsible for alteration of oligodendrocytes and astrocytes, affecting the myelination and organization of the cerebral cortex

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